Publishers Weekly® Reviews
- Reviewed in: Publishers Weekly, page 39.
- Review Date: 2009-11-30
- Reviewer: Staff
That humblest of quality-control devices, the checklist, is the key to taming a high-tech economy, argues this stimulating manifesto. Harvard Medical School prof and New Yorker scribe Gawande (Complications) notes that the high-pressure complexities of modern professional occupations overwhelm even their best-trained practitioners; he argues that a disciplined adherence to essential procedures—by ticking them off a list—can prevent potentially fatal mistakes and corner cutting. He examines checklists in aviation, construction, and investing, but focuses on medicine, where checklists mandating simple measures like hand washing have dramatically reduced hospital-caused infections and other complications. Gawande gets slightly intoxicated over checklists, celebrating their most banal manifestations as promethean breakthroughs (“First there was the recipe, the most basic checklist of all,” he intones in a restaurant kitchen). He's at his best delivering his usual rich, insightful reportage on medical practice, where checklists have the subversive effect of puncturing the cult of physician infallibility and fostering communication and teamwork. (After writing a checklist for his specialty, surgery, he is chagrined when it catches his own disastrous lapses.) Gawande gives a vivid, punchy exposition of an intriguing idea: that by-the-book routine trumps individual prowess. (Jan.)
The power of one very simple tool
Atul Gawande writes for The New Yorker, but by trade he‘s a surgeon; after a particularly harrowing operation in which the patient nearly died, he took a hard look at what had gone wrong and he found that a simple error had nearly doomed his patient. Not long after, he happened upon an anecdote that piqued his interest—an account of an Austrian community hospital where a girl had been brought back from apparent brain death due to drowning. Intrigued, he began searching the literature for a confirmation of what had occurred in Austria, and he found it in a Johns Hopkins study detailing a reduction in infections after surgery. They had one factor in common, and that was the use of a checklist.
The Checklist Manifesto is Gawande’s account of this “aha!” moment, and his search—under the auspices of the World Health Organization—to find out if something as simple as a checklist could improve patient survival rates. The quest led him in many different directions, one of which was the obvious idea of trying it out in real-life situations. As he recounts, this was not as easy as it might seem, because surgeons as a rule are confident and headstrong and don’t take kindly to being second-guessed by a sheet of paper. It also led him to the construction industry and the complex process of building a skyscraper. To ensure that tasks get done correctly (and to keep the thing from collapsing), construction engineers use—you guessed it—a checklist. Finally, Gawande gained some priceless insight from the aviation industry.
Unless you avoid newspapers and television, you’ve probably heard of Captain “Sully” Sullenberger, the pilot of US Airways Flight 1549. After taking off from New York City’s LaGuardia Airport on January 15, 2009, the plane struck a flock of geese, unbelievably losing both engines in the process. While he was justly heralded for gliding the airliner to a safe landing in the Hudson, Sullenberger resisted efforts by the press to make him a hero, insisting that it was a team effort. Gawande points out that today’s modern airliner is so incredibly complex that no one person, or even a team of people, can operate one safely on their own; the crew of Flight 1459 relied on a simple tool during their forced landing. That tool is one that has been used by pilots everywhere almost since the dawn of aviation—the checklist.
Atul Gawande’s determined effort to see his theory through is at the heart of The Checklist Manifesto, and its implications are widespread; he shows us a simple tool for complex problems that can be applied to business, government and just about any situation where unanticipated complications can lead to disaster. It remains to be seen whether this surgical Cassandra’s solution will be heeded.
James Neal Webb works for the Vanderbilt University Library.