Roam Notes on “The Checklist Manifesto” by Atul Gawande

  • "Title::" The Checklist Manifesto: How to get Things Right
  • "Author::" [[Atul Gawande]]
  • "Reading Status::" #Complete
  • "Tags::" #Productivity #organization #process #Management #coordination #checklists #planning
  • Overview

    • [[Atul Gawande]] is a famous surgeon, writer, and public health researcher. This book is an ode to simple checklists as an extremely powerful tool to aid process and quality improvement, especially in situations where there is a lot of [[complexity]] and [[coordination]] required. The author became interested in checklists as a tool in his surgical practice, and the book points to many examples of how checklists improve [[efficiency]] and [[safety]] in a variety of situations.
    • A common theme in the book is the fallibility of human beings and the importance of acknowledging these shortcomings. The author points to examples where excellent surgeons and other professionals have made serious and "obvious" errors. It’s easy to dismiss these errors by blaming the person committing them as incompetent or lazy, but the fact is, without proper systems, these mistakes will happen regardless of how well trained or skilled a person is. Properly designed checklists can provide a crucial safeguard.
  • Excerpts

    • Three Different Levels of Complexity for Problems in the World (pg. 49) #complexity #[[problem solving]] #[[To Ankify]]
      • Simple: there is a recipe. Sometimes there are a few basic techniques to learn. But once mastered, following the recipe bring a high likelihood of success. #[[simple problems]]
      • Complicated: Can sometimes be broken down into a series of simple problems, but there is no straightforward recipe. Success often requires multiple people, multiple teams, and specialized expertise. Unanticipated difficulties are frequent. Timing and coordination are serious concerns. E.g. sending man to the moon. #[[complicated problems]]
      • Complex: Problems where the solution is not repeatable, and outcomes remain highly uncertain. Expertise is valuable but not sufficient. E.g. raising a child. [[complex problems]]
      • This distinction was developed by [[Brenda Zimmerman]] of [[York University]] and [[Sholom Glouberman]] of [[University of Toronto]] in their study of the science of complexity.
      • Note that many problems in engineering and operating a business are simple or complicated, and thus can be aided by [[checklists]].
    • How Skyscraper Engineers Build Checklists (pp. 62, 70) #engineering #coordination
      • Since every building is a new creature with its own particularities, every building checklist is new, too. It is drawn up by a group of people representing each of the sixteen trades… Then the whole checklist is sent to the subcontractors and other independent experts so they can double-check that everything is correct, that nothing has been missed.
      • They rely on one set of checklists to make sure the simple steps are not missed or skipped and in another set to make sure that everyone talks through and resolves all the hard and unexpected problems.
      • The biggest cause of serious error in this business is a failure of [[communication]]
      • [[Mark’s Notes]]: This almost magical process ensures that the knowledge of hundreds or thousands is used in the right place at the right time in the right way.
    • Why Dictating from the Top Fails in Complex Situations (pg. 79) #micromanaging #decentralization #centralization #complexity #Management
      • under conditions of true complexity – where the knowledge required exceeds that of any individual and unpredictability reigns – efforts to dictate every step from the center will fail. People need room to act and adapt. Yet they cannot succeed as isolated individuals, either – that is anarchy. Instead, they require a seemingly contradictory mix of [[freedom]] and [[expectation]] – expectation to coordinate, for example, and also to measure progress toward common goals. #leadership
      • [[Mark’s Notes]]: The example in the book is the [[Katrina disaster]]. [[FEMA]] tried to centrally control everything. In contrast, [[Walmart]] helped the community very effectively – its leadership sent a clear message to do what’s right, and do what you can to help these people in trouble.
        • Also, the skyscraper builders understand this, and learned to codify this type of [[decentralization]] in [[checklists]]. They have checklists for simple tasks, combined with checklists to make sure everyone is coordinating and communicating with each other. There must be judgement, but judgement must be aided / enhanced by procedure.
    • Good Checklists Versus Bad Checklists (pg. 120) #checklists #[[how to make checklists]]
      • Bad [[checklists]] are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb and try to spell out every single step. They turn people’s brains off rather than turn them on.
      • Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything – a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps – the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.
    • The Most Common Obstacle to Effective Teams (pg. 163) #coordination #teamwork #communication #[[To Ankify]]
      • The most common obstacle to effective teams, it turns out, is not the occasional fire-breathing, scalpel-flinging, terror-inducing surgeon, though some do exist … No, the more familiar and widely dangerous issue is a kind of silent disengagement, the consequence of specialized technicians sticking narrowly to their domains. ‘That’s not my problem’ is possibly the worst thing people can think, whether they are starting an operation, taxiing an airplane full of passengers down a runway, or building a thousand-foot-tall skyscraper.
    • Key Decisions to Make when Building Checklists (pp. 123-124) #[[To Ankify]] #checklists #[[how to make checklists]]
      • Define a clear pause point (point at which the checklist is supposed to be used)
      • Decide on whether you want a DO-CONFIRM checklist or READ-DO checklist.
        • DO-CONFIRM – team members perform a job from memory and experience, often separately. But then they stop. They pause to run the check-list and confirm that everything that was supposed to be done was done.
        • READ-DO – people carry out the tasks as they check them off – more like a recipe
      • Test it: “no matter how careful we might be, no matter how much thought we might put in, the checklist has to be tested in the real world, which is inevitably more complicated than expected” #testing
        • [[Mark’s Notes]]: Sometimes, testing is not easy to do. That’s why they have simulations in aviation and the author tried a similar test for surgery with his surgical team and a dummy.
    • How Not to Respond to Failure (pp. 185-186) #failure #Systems #fallibility
      • We are all plagued by failures – by missed subtleties, overlooked knowledge, and outright errors. For the most part, we have imagined that little can be done beyond working harder and harder to catch the problems and clean up after them. We are not in the habit of thinking the way army pilots did as they looked upon their shiny new Model 299 bomber – a machine so complex no one was sure human beings could fly it. They too could have decided just to ‘try harder’ or to dismiss a crash as the failings of a ‘weak’ pilot. Instead they chose to accept their fallibilities. They recognized the simplicity and power of using a checklist.
        • [[Mark’s Notes]]: It is such a common sentiment to blame failure on people’s abilities or motivations.

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