Book Review - The Checklist Manifesto by Atul Gawande

Book Review - The Checklist Manifesto by Atul Gawande


4 min read

I came across a small book of Atul Gawande's recently. If you don't know him, Atul Gawande is a well-known surgeon, researcher, and writer, best known for his book, Being Mortal.

The book, The Checklist Manifesto, deals primarily with the idea of managing complexity. He distinguishes the idea of the complex from that of the complicated, similar to the way Stanley McChrystal does in his book on leadership in complexity, Team of Teams. Something that is complex is highly unpredictable and has no clear answer, like raising a child, fighting an insurgency, or dealing with human beings. Something that is complicated may be extremely difficult, but the knowledge exists to get it done, like building a plane or a car (arguably).

As Dr. Gawande is a physician by trade, he discusses complexity in the field of medicine, in which, scary as it may be, there often really are no clear answers. He also explores various other worlds such as that of construction and that of flying planes. As our world gets more and more complex, as it seems to be, the question arises of what we can do to prepare people for situations in which there is no playbook. More training? More piles of books with best practices? Dr. Gawande explores a "solution" of sorts that may not solve complexity, but has helped many complex industries reduce preventable disasters. And it is so simple, it sounds stupid.

A checklist.

Now I've known that checklists were used by pilots and astronauts before, and I've also known they often go through years of simulations and training. But it's interesting to universalize this idea. Many lessons learned fill the pages of history and in one example Dr. Gawande uses, flying planes, these lessons are captured in a book of checklists pilots keep. Imagine if these lessons were instead spread out in thousands of articles and books, and you can understand how this might be useful.

One thing Dr. Gawande writes about are checklist items that ensure medical professionals introduce themselves to one another before a surgery, or go around and say if they have any concerns. While this may sound annoying and dumb, I can imagine it can do wonders to the group dynamic, just like a silly name game at the start of a group outdoor adventure.

Speaking of annoying and dumb, let's talk about something called Agile Methodology. Agile is a term that (primarily software) companies have adopted in recent years that refers to a mindset of developing "requirements and solutions through the collaborative effort of self-organizing and cross-functional teams and their customer(s)/end user(s)" (Wikipedia). One such agile framework that is extremely popular is called Scrum. One ritual of scrum is that of the daily stand-up. Obviously it's often easier to hate on a system when you're not in charge of it. However, thinking from a checklist mindset, perhaps these agile frameworks do do some good, in terms of facilitating communication, just like introductions at the start of surgery.

Note that The Checklist Manifesto was written in 2009, only two years after the iPhone was first released. I'm writing this in 2020, and I can tell you, a lot has changed in the world since then. One thing, of course, is that more people are looking into such things using big data and artificial intelligence to solve issues and improve outcomes in many different industries. The scope of problems this solves, we'll have to see in the next decades. Regardless, along with clinging to Hail Mary hopes, I think it could do many people good to take a few steps back and see if a simpler idea can solve their issues. Maybe you'll realize there already exist solutions so much simpler than you'd imagined. In some cases, maybe something as stupid as a checklist.

Disclaimer: As with all my book reviews, this by no means covers the entire span of topics from this book and I encourage you to read it if I say something interesting.