Checklists?that?s what this book is all about. Though the subject may sound simple, Atul Gawande, the New York Times bestselling author of Better and Complications, once again in a riveting read brilliantly argues why after all it?s not as simple as it may seem to be. As it turns out, irrespective of our respective professions, we all can-do-better with checklists, and as the book tells us, it?s no mean task to arrive at the right one.
During his surgical training back in the 1970s, Gawande read a short essay on the nature of human fallibility by philosophers Samuel Gorovitz and Alasdair Macintyre. He hasn?t stopped pondering over it since. One reason, Gorovitz and Macintyre argued, why we fail at what we set out to do in the world is ?necessary fallibility?. Simply put, some things are just beyond human capacity?after all not everyone can be omniscient and all-powerful. But in realms where we can exercise control, we may fail either due to ?ignorance? or ?ineptitude?. Ineptitude here is the key word because it implies the existence of knowledge but failure to apply it correctly. Gawande observes how greatly the balance between ignorance and ineptitude has shifted in the past few decades even as science filled in enough knowledge to make ineptitude as much our struggle as ignorance. ?Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated. What do you mean half of the heart attack patients don?t get the treatment on time? What do you mean that two-thirds of death penalty cases are overturned because of errors??
And that?s where the role of checklists comes in??as a strategy to overcome failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies.? No arguments here?not after you are told that the World Health Organisation distinguishes more than 13,000 different diseases, syndromes and injuries and some 6,000 drugs and 4,000 medical and surgical procedures with their respective requirements, risks and considerations. The complex gets more complex and even superspecialisation begins to seem inadequate. Given the complexity, therefore, it is anybody?s guess what the chances for getting it all right will be.
And extreme complexity, as Gawande points out, is the rule for any profession. In fact, the strategy of checklist was first introduced generations ago by the US Air Force to enable its pilots fly ultra-sophisticated aircraft. And there is enough evidence to point out that checklists do work. A simple five-point checklist to avoid infections while putting in the central line at the John Hopkins Hospital in the US saw a significant drop in the infection rate from 11% to 0%?in the process preventing 43 infections and eight deaths and saved two million dollars in cost.
Investment bankers have it too. Even engineers who construct skyscrapers have broken complex tasks into simple checklists to eliminate the possibility of any errors. Restaurants have checklists too to maintain the incredible consistency of taste?the recipe. Even if the chef has made the same dish a 100 times over, he must still ?read and follow the recipe?.
Even rocker David Lee Roth (Van Halen) had a clause in the contract with its concert promoters that demanded a bowl of M&Ms to be provided backstage, but with every single brown candy removed. It wasn?t just a clause in a bulky contract though. It was Roth?s ingenious way to ensure that other important technical specifications in the contract were taken care of too. At least on one occasion, in Colorado, the band found that local promoters had failed to read the weight requirements and the stage could have collapsed.
The book lists plenty such instances, making it an essential read for anyone who wants to do better. Irrespective of what you do for a living, pick it up? there?s a lesson in there for everyone.