The Checklist Manifesto - Atul Gawande

It is clear that the turn of the century, the Digital Transformation, the rise of the Internet, the global interconnectivity, and the Fourth Industrial Revolution as a whole have revolutionized our understanding of how the world works and how we manage knowledge.

The human being - despite having walked on the moon, being able to solve problems on a global scale, and being in constant evolution - is not omniscient, let alone omnipotent.

Regardless of the advances provided by technology, our physical and cognitive abilities are still limited. Much about the workings of the universe - most of it, in fact - is beyond our understanding or control.

Nevertheless, there are essential domains in which management and understanding are within our grasp. Humanity is capable of designing skyscrapers, anticipating natural phenomena, and saving people in infinite ways using medicine. But still, we make mistakes.

But don't worry! Atul Gawande brings in his book “The Checklist Manifesto” a tool capable of optimizing and managing processes, so that there is error reduction and continuous improvement. It is simple to implement and you certainly already know it, but you don't know how revolutionary it can be!

We are talking about a checklist! Continue reading this summary to understand how important it is and how using it in the development of your tasks can be transformative!

About the book “The Checklist Manifesto”

“The Checklist Manifesto: How To Get Things Right”, is a 225-page book that consists of 9 chapters of analysis of practical situations where checklists act to reduce risks, errors, losses, and also to improve processes.

The book is based on real applications of the use of checklists in several areas, sectors, and circumstances, such as in the medical and hospital sector, in large civil constructions, in the aviation area, and even in cooking processes.

About the author Atul Gawande

Atul Gawande is a surgeon, and practices medicine at Brigham and Women's Hospital and the United States Center for Surgery and Public Health. In addition, he is a professor at Harvard's School of Public Health and School of Medicine.

Gawande is a best-selling author and an expert in analyzing and reducing errors, expanding the effectiveness of surgical interventions, and promoting greater safety in the hospital setting. For this reason, he writes books and publications in the health area, defending the efficiency of checklists in good management strategies.

To whom is this book dedicated?

This book is indicated for people who want to know tools that can optimize tasks and reduce possible process failures, especially when it comes to managing complex activities that demand a lot of time, people and requirements, or advanced knowledge and data.

Main ideas of the book “The Checklist Manifesto”

• Despite great advances in science and technology, human beings are not able to manage all the knowledge without the help of tools;
• There are two main reasons why we make mistakes: lack of knowledge or its incorrect application;
• Organizing priorities into lists reduces our need for cognitive effort and makes us focus on the essentials;
• All areas and activities can be improved with the use of checklists, as long as they are used in the right way;
• Activity checklists should be constantly improved, considering the contexts in which they are applied.

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How to solve a problem of extreme complexity?

In his book “The Checklist Manifesto”, Atul Gawande states that there are only two reasons why we fail: ignorance and ineptitude.

How does ignorance make us fail?

Errors of ignorance happen because science itself can offer only a partial understanding of the world and how it works.

There are limits to the skyscrapers we can build, unpredictable phenomena, or situations that medicine is not yet able to completely solve, such as the Covid-19 pandemic.

In these cases we make mistakes or fail to solve problems because we don't have the necessary knowledge to do so.

How does ineptitude make us fail?

The second type of error is known as inaptitude, because in these cases the knowledge exists, but we fail to apply it.

This applies to buildings that collapse due to poor design, phenomena for which meteorologists have not interpreted the signals correctly, or surgeries in which medical errors occur.

The balance between ignorance and ineptitude

Atul's book reflects about the variation in the balance between ignorance and inaptitude over the centuries, where a large part of human history has been governed mainly by ignorance.

One of the areas where this variation in balance is most evident is Medicine, where, decades ago, our knowledge was extremely limited and we had little control over diseases, what caused them, and how to treat them.

It was only in 1938 that penicillin was isolated, for example, while today we are able to develop vaccines for a virus with global pandemic impact in a fraction of the time compared to the creation of the antibiotic.

The point is that in the last few decades science has been able to make revolutionary and constant discoveries, acquiring enough knowledge to make inaptitude, in other words, the acquisition and administration of so much information, as serious a problem as ignorance.

Why do even the experts fail?

Even for those who spend decades studying and practicing their knowledge, failures still occur and persist, despite the great individual ability of experts. This is justified by the knowledge accumulated and produced since the beginning of the 21st century.

Highly qualified and trained people develop extraordinary things. Yet knowledge is unmanageable in all areas, from philosophy to physics, medicine to business, finance to government.

The volume of what we know has exceeded our capacity to absorb information, with the result that knowledge is not always applied in the right, reliable, or safe way. We are overloaded.

What are the benefits of using a checklist?

Based on this, their activities have become too complex to rely on memory alone to perform them reliably. This is where checklists are the indispensable tool for dealing with information management.

Perhaps at this point you are skeptical about the effectiveness of checklists in such complicated activities, but we promise to convince you by the end of this PocketBook!

The book “The Checklist Manifesto” states that using task checklists in our work environment and in our personal organization will serve to ensure that we remember the minimum necessary for an activity to be performed in the right way.

Checklists also work on our high performance discipline, as well as standardizing a foundation of quality performance. Gawande claims that they provide a "cognitive network," where they are able to detect gaps in attention and thoroughness, reducing our rational effort to reallocate it elsewhere.

A fundamental step, according to the author, is to be aware that the application of checklists has its limits, and that we must verify under what circumstances they can help or harm us.

How and when can I use a checklist?

Checklists should be used in two main situations: for knowledge management and for communication efficiency.

They are also divided into “READ-DO” where each step is performed after checking for its existence, or “DO-CONFIRM” where the list is inspected and all activities are done next and then validated.

Each type of list should be applied depending on the circumstances of its purpose.

Knowledge Management

In this case, checklists are made to ensure that the activities required in a certain process are not forgotten or carried out in the wrong way.

They should be used especially for managing teams with different functions, specialties, and application areas, because a list ensures that the right activities are performed by the right people, at the right time, and in the most appropriate way.

So checklists should target the activities for each purpose, segmenting teams or areas and listing their main responsibilities.

Effective Communication

We know that most of the time things don't go exactly as planned, and that during the execution of an activity there can be unforeseen events or problems that, at first, were not expected when we planned our to-do list.

In this case, checklists are responsible for providing efficient communication between the people who can solve our problems.

Therefore, the checklist for effective communication should list who we should communicate with when a problem with a certain cause occurs, how we can get in touch, how it is possible to contact experts, and how the problem is being followed up and recorded.

Communication checklists are effective in surprising and atypical situations, where conditions are unpredictable and constantly changing. In these situations it is impossible to organize a task list, but you can get people to communicate to solve the problem collectively.

How to assemble an efficient checklist?

An efficient checklist consists of a short list of essential tasks, which can be branched and segmented according to the circumstances of each application. Atul Gawande states that it is better to have several checklists for each situation or step in a process, rather than one long list for the entire project.

In “The Checklist Manifesto”, we also understand that task lists should be easy to use and accessible to everyone who has some responsibility listed, even in the most complex or difficult situations.

The book also suggests that strategic breaks should be taken to analyze performance so far, where possible impediments should be discussed, opinions and suggestions heard, and certain doubts of those involved clarified.

The number of tasks on a list varies depending on the context, but Atul Gawande warns about the attention that must be paid when choosing the key objectives.

This is justified because if we reduce a list too much, we may not have enough checks to ensure good performance, while if we have too many checks, users will lose focus and productivity.

Finally, the book suggests that the language of the list be simple and exact, equivalent to that used by the professionals who will execute it.

Not assemble a bad checklist is as important as assemble a good checklist

The structuring of a task list can be wide and adaptable, yet there are factors that, regardless of the checklist's development function, can only hinder its performance.

Therefore, Atul Gawande states that it is essential that the lists are not too long, and that they have the main focus on what is indispensable. This is necessary so that attention is not diverted from what is more important, or so that we don't spend more time analyzing the list than executing it.

Another point to be avoided is listing very trivial or basic points, so that the checklist focuses on the more complex and detailed parts of a process.

A clean and responsive design is also indispensable, avoid flashy elements or colors that may impair the visualization and understanding of the message.

In addition, bad checklists are vague and imprecise, which leaves room for different interpretations of the same task or different implementations than expected. So always focus on the essentials.

How do checklists work in continuous improvement?

No matter how attentive and careful we are when producing and executing checklists, regardless of how much thought we put into creating them, it is only with their application and verification of its operation in the real world, which is inevitably more complicated, that we will be able to assess its effectiveness.

Atul Gawande states in “The Checklist Manifesto” that first lists will never be perfect, are susceptible to errors, and need critical analysis so that we observe their efficient execution points and those that need improvement.

Therefore, you need to develop different checklists for different contexts, conditions, and purposes, and still study how changes, tests, and improvements can be implemented until your checklist works consistently.

What do other authors say about it?

In “Managing the Millennials”, Chip Espinoza and Mick Ukleja address the competencies needed for efficient management nowadays, contextualizing the way the millennial generation is changing the way we work.

Greg McKeown, author of “Essentialism: The Disciplined”, deals with the main strategies for us to perform more productive activities, as well as techniques to optimize processes and manage time, always by focusing on what is essential.

Finally, in the book “Noise: A Flaw in Human Judgment”, by Daniel Kahneman, Oliver Sibony, and Cass R. Sustein, we understand how noise and biases are capable of impairing communication and decision making, and how to reduce or eliminate them.

Okay, but how can I apply this to my life?

• Analyze which tasks you develop that are more susceptible to errors, or which need more attention, these activities should be the focus of your checklist;
• Define who are the people involved in your project and present them with your management proposal, so that everyone is aligned about how its operation; 
• Determine what are the key activities of your objective, which cannot be forgotten or performed incorrectly;
• Adapt your checklists to your conditions, the list should not be cast in stone or unquestionable;
• Try to look critically at your task lists and find improvements in execution for the creation of the next ones.

Did you like this summary of the book “The Checklist Manifesto”?

You already knew that we are overloaded with knowledge in the Information Age. But could you imagine that a tool as simple as a task checklist could help our organization, attention, memory, communication, and time management?

Now you know how to assemble checklists for process optimization, regardless of what it is. Are you ready to start?

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