The Checklist Manifesto

The Checklist Manifesto

You Will Not Want To Put It Down!


The Checklist Manifesto by Atul Gawande – a leadership-style book that is an excellent and engaging read.


If you have not already done so, read this book! You will not regret a single minute’s reading. It is filled with information and ideas for incorporating them into your personal and professional experiences.


It is a page-turner and thus a quick read. It left deep impressions on me and evoked several “ah-ha!” moments.


A few I Power Seeds based on The Checklist Manifesto


Warning: The following contains a glimpse into the book. For those of you who avoid spoilers at all costs – alert – read the book before reading the following. For those who can handle a preview and some takeaways, keep on reading.


The book contains vivid true stories and situations that will stick with you and you will find yourself reflecting back on again and again. One story has to do with an emergency operating room, a critically wounded patient who was the victim of a stabbing and root cause analysis.



We Don’t Know It All

  • Regardless of our knowledge and length of time in our professions, we don’t know it all. Many challenges are now more complex and previous go-to solutions or fixes are often inadequate or obsolete.
    • We all need to work well together. Even high-level specialists, rely on others across the team to complete their time-sensitive and critical functions as part of the holistic solution.
  • The days of ‘general surgeon’ are long gone.
    • Now surgeons focus within a particular specialty. Current technology is another example of complexity. Coding, servers, and networks 15 years ago were much simpler than today’s evolved and significantly more complex technologies providing services in today’s technology industry is much more complex too. For example, a Cisco Certified Network Associate (CCNA) now has numerous specialties.

Checklists and Solutions

    • Traditional methods or practices are not always foolproof.checklist
    • The simple suggestion for implementing a checklist in an operating room was initially not welcomed, even overlooked. Later, it was credited for saving lives.
    • Timing is everything. Administering a surgical patient an antibiotic within 60 minutes of the first incision reduced infections by 50%. Even giving the same antibiotic 30 seconds before an incision showed significant effectiveness as well. Wait longer than 60 minutes and the antibiotics could ware off and be ineffective.
    • The book highlights a statistic that is incredible – half the patients in one study had to have their surgeries redone or fixed as a result complications or errors from the original procedure. How many times do we have to go back and fix something caused by errors that could have been avoided by utilizing a checklist? What comes to my mind is the old, nearly fool-proof, saying, “measure twice, cut once.”
    • There are many steps to complete complex solutions.
    • Major advances over the past several decades are attributed to tracking and communication. As an example, buildings are built safer, now a .0002% failure rate and are constructed in a third of the time due to mandatory and detailed checklists.
    • The author asks us to identify our personal tolerance levels relevant to “acceptable.” Incentives play a significant part in goal achievement. (I think this is something we all know, but maybe overlook.)

Root Cause (example)
The book highlights the example of Dr. Snow related to his work in tracing the source of an outbreak of cholera in London, in 1854. At the time everyone thought cholera was airborne. Dr. Snow went on a hunch. He felt it was something else. He was creative and looked outside the norms to map it out leading him to discover the source was a water well that had a cesspool leaking into it. He found the root cause which inspired the adoption of fundamental changes in water and waste systems. He is credited for a significant improvement in general public health around the world.

washing hands with soap

Always Use Soap (example)
•  Another example in the book was the availability and use of hand soap to help rid the geographical area of illness and disease in Karachi. Diarrhea, pneumonia, etc. fell as much as 50% in one year by utilizing soap with an antibacterial agent in it. The sad part is the residents had soap, but they were poor and wanted to “save it.” Handing out free soap resolved that part of it.

•  The second part came down to instruction on washing significantly more, routinely, and properly. The free soap smelled and felt good, even better than the soaps they were saving, so it encouraged them to use it more frequently and longer, thus reducing illness causing bacteria.

•  So much of our common knowledge and many of the practices we take for granted today were unknowns in previous times.


Speak Up and Listen (example)
Another example in the book has to do with a surgical assistant who did not speak up and a surgeon that the assistant worked with who did not like to listen to and accept observations from others. The author provides examples of where speaking up could have prevented failure and/loss of life. The author also provides other moving examples on the importance of speaking up and listening.


Final thoughts on Checklist Manifesto
Many of the doctors in the studies highlighted in the book were change adverse as were many of the hospital administrators who did not want to enforce a checklist policy, but when 24 people from one very small study survived because of the proper use of a good checklist the results speak for themselves. As a patient, wouldn’t you want the team treating you or your loved ones to utilize a simple checklist?


Short-term thinking people complain about checklists as they say it adds time and effort to sometimes chaotic timetables and schedules. What they fail to realize, is that checklists actually reduce gaps in wasted time and resources and often mitigate touching things twice.


Many think checklists are beneath us, or that they reflect weaker minds. We have had a strong held belief that the great minds don’t need notes or checklists. Sound familiar? Checklists remove human egos, especially when highly skilled and experienced people are working together. A checklist removes the subjectiveness and interpretation between people.


This was a great book that I could not put down. Go get it and read it – you will really enjoy it.


Please leave any comments on the site.

Here is a demonstration of a failed attempt to use the WHO Safe Surgery Checklist. This clip shows how implementation of the Checklist without obtaining buy-in from clinical staff and providing appropriate education in the checklist use.

Please also watch the video on how to use the checklist in a fashion that improves patient safety:

Here is a summary of the book: 

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