In his latest book The Checklist Manifesto, the Harvard School of Medicine professor and staff writer for New Yorker (among the polymath’s many other vocations) makes a compelling case for the use of simple checklists for greater efficiency and enhanced safety in all aspects of life.[break]
In his crisp account of checklists spanning just over 200 pages, Gawande narrates his experiences as a general surgeon at the Brigham and Women’s Hospital in Boston.
In his pioneering work there, he introduced checklists to drastically reduce infection rates among surgery patients, which are among the primary causes of post-operative mortality.
Before the first incision, simple procedures like hand washing and properly cleaning up the surgery area, among the vital points included in Gawande’s pre-surgery checklist, were enough to cut down central-line related infections by 66 percent.
Checklists are particularly useful in a complex field like medicine. To gauge the level of such complexity, consider this example from The Checklist Manifesto:
“Over a one-year of office practice… physicians [at a private medical care provider] each evaluated an average of 250 different primary diseases and conditions. Their patients had more than nine hundred other active medical problems”.
This, Gawande reminds us, “excludes the patients [these doctors see] in the hospital”.
In such a complex scenario, Gawande argues, the challenge is not to get the ‘big things’ right, which thoroughbred professionals do in any case, but to minimize the small slips that in the final reckoning can make a huge difference.
In the medical practice it is not just enough to diagnose a particular disease; while treating a patient a doctor must also be aware of his major allergies (if any), his past medical records, the medicines he might be taking, the side-effects of any treatment plan and a whole load of other things, overlooking any one of which could be the difference between life and death.
But the author is not content on establishing the value of checklists in medicine. Thus when he quizzes structural engineers, Gawande discovers that famous builders also use checklists (and checklists of checklists) to make complex tasks more manageable.
While working on a big housing project the Master Builder has to coordinate between as many as 16 different agencies (ranging from the brick-and-mortar layers, air-conditioning crew to the escalator installers).
In such a complex setting, even a minor mistake can have major consequences.
For instance, a few rivets missing from the supporting metal-structure of a colonnade can bring the whole structure down in the event of a severe storm.
If the skyscraper under construction is in a major US city, the builders have to guard against not just inclement weather. In the aftermath of 9-11, there have been thorough revisions of the US building codes.
One of new engineering concerns is preventing the cascading effect witnessed in the Twin Towers when their top floors collapsed after two jetliners crashed into them. And as the standards of infrastructure development has gone up, the margins for error have progressively climbed down.
Flying an aircraft is another incredibly difficult task for a pilot without the support of the cabin crew, and yes, checklists. Without going through a set routine of pre-flight checks, it is easy for a pilot to miss a simple step.
On October 30, 1935, Boeing’s Model 299 crashed in a test flight in Dayton, Ohio, killing two crew members on board. The investigation report revealed not a mechanical glitch but rather a “pilot error” as the cause of the fatal crash.
The pilot had apparently forgotten to flip an important switch. Reporting on the incident, a local newspaper wrote at the time that the new Boeing model was “too much airplane for one man to fly”. So what did the Boeing do to prevent such slip ups in the future? Why, of course, conjure a pilot’s checklist!
It isn’t hard to see how checklists can help us accomplish even day to day tasks with greater ease. In the hustle and bustle of modern-day living, it is easy to forget routine tasks like picking up the grocery from the supermarket or remembering to carry home your wife’s favorite sundae on the way, neither a portent of blissful conjugal life.
Some might belief that they can dispense with the bothersome lists by ‘naturally’ remembering things, if not on their own than with the aid of the various mnemonic books now available in the market. Indeed.
Every street corner you see a poster advertising the amazing effects of a memory course which will transform your life by revolutionizing the way you “perceive and memorize”. But amazing as some of these techniques are truly are, they are at best temporary solutions.
Experience tells us (certainly this reviewer) that a simple checklist of important events, although it surely doesn’t sound as neat as simply remembering things unaided, is a very reliable method.
One more thing. When I finished reading The Checklist Manifesto, I couldn’t help thinking: would Nepal have had a new constitution by now if the CA members had at the start of the drafting process kept a checklist of the things to do, or had they agreed on common minimum standards on the statute? Likely.
More than one constitution expert now believes that the major flaw with the ongoing peace and constitution process was the failure of the major parties to set clear goalposts right off the bat.
The Checklist Manifesto is an intellectual treat and should be a fun read for anyone into social psychology and myth-busting works of Malcolm Gladwell like Blink and The Outliers. Writers like Gladwell and Gawande deal in the unconventional: by making us aware of how we tend to completely miss (or misinterpret) the most vital pieces of information from any event while divining the ‘obviously rational’ (but wrong) messages. Pick it up.
Even if you aren’t convinced by Gawande’s arguments, you will come away impressed by his almost surgical precision with words.
The writer is the op-ed editor at Republica
Related story
Dreams deferred, not destroyed
