The Checklist Manifesto by Atul Gwande, 2009
Atul differentiates two types of problems that we face when dealing with extreme complexity. One is that of ignorance, there is a lot we simply don’t know. Unpredictability is a facet of complexity that many writers on the subject of complexity have given plenty of attention to, along with possible ways of managing that unpredictability. The other problem that Atul identifies is that of ineptitude. This is our inability to make good use of knowledge that is already available. He gives many examples where complex bodies of knowledge already exist that can make a big difference to people’s lives, notably in the field of medicine. But because of the very scale of those bodies of knowledge the reality is that people often are not cable of making full use of it and sometimes the consequences are disastrous. This facet of complexity is not something I’ve seen given very much attention to in the literature on complexity, at least that which I have come across. So I read this book with great interest, an interest magnified no doubt by my previous interest in, and experiments with, the use of weighted checklists, which are documented elsewhere on this website.
Another distinction that he makes is between task checklists and communication checklists. The first are all about avoiding dumb mistakes, forgetting to do things we should know that have to be done. The second is about coping with unexpected events, and the necessary characteristics of how we should cope by communicating relevant information to relevant people. He gives some interesting examples from the (big) building industry, where given the complexity of modern construction activities, and the extensive use of task checklists, there are still inevitably various unexpected hitches which have to be responded to effectively, without jeopardising the progress or safety of the construction process.
Some selected quotes:
- Checklists helped ensure a higher standard of baseline performance.
- Medicine has become the art of managing extreme complexity – and a test of whether such extreme complexity can, in fact, be humanely mastered”
- Team work may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise…But the evidence suggests that we need them to see their job not just as performing their isolated set of tasks well, but also helping the group get the best possible results
- It is common to misconceived power checklists function in complex lines of work. They are not comprehensive how to guides whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals. And by remaining swift and usable and resolutely modest, they are saving thousands upon thousands of lives.
- When you are making a checklist, you have a number of key decisions. You must define a clear pause point at which the checklist is supposed to be used (unless the moment is obvious, like when a warning light goes on or an engine fails) you must decide whether you want a do-confirm checklist or read-do checklist. With a do-confirm checklist team members perform their jobs from memory and experience, often separately. But then they stop. They paused to run the checklist and confirm that everything that was supposed to be done was done. With the read-do checklist, on the other hand, people carry out the task as they check them off, it’s more like a recipe. So for any new checklist created from scratch, you have to pick the type that makes the most sense of the situation.
- We are obsessed in medicine with having great components – the best drugs, the best devices, the best specialists – but paid little attention to how to make them fit together well. Berwisk notes how wrongheaded this approach is ‘anyone who understands systems will know immediately that optimising part is not a great route to system excellent ‘he says.
I could go on, but I would rather keep reading the book… :-)
