The title of the book makes it obvious for anyone what’s in store for them in the book. At some point of time or the other, we all would have made a list of something in our lives… Grocery list, Books to read list, Things to do list, Steps in an algo while coding, List of aspects to be checked in unit testing/system testing, List of steps in a process (that is outsourced to a call center where standardization is the key) , List of items to be back packed, etc.

Personally I like making a checklist even if the list is not more than 4 items long. The very fact that you tick off the item after you complete a task gives me some kind of feel good effect that you have accomplished whatever you had intended to. In one way it also quantifies things that you have in your mind. those 6 books that you wanted to read, those 5 things you need to have while taking a customer call ,  those 9 items you should buy at a grocery store etc .. In that sense a checklist is a nice and simple quantification mechanism, a recall mechanism for our attention strapped life.

Ok, now is there a book worth of stuff relating to checklists ?  If the would have been written by a management consultant, or a self help guru, I wouldn’t have bothered to even cast a glance at it . But the fact that it is written by a doctor who talks about the usage in the medical field is something that caught my attention. Medical field  at the outset seems like a field where there is no scope for standardization as every patient needs to be treated differently. However the author says checklist can get things right in medical that should any reader some one curious to see how a simple check list can be useful.

The book starts off with a few examples of doctors who have gained enormous experience in surgery, became highly skilled over their careers , but still fail to do things in an organized way while performing surgeries.  So, what’s missing ?

The author brings out a fundamental puzzle in modern medical world. Because of sophisticated treatment procedures, a doctor needs to keep track of innumerable tasks and more often than not , he/she adopts specialization to super specialization path. This solution has not been quite effective as there are about 150,000 deaths following surgery in US every year, more than 3 times the road casualties.

The book  takes a tour of various domains where checklists have been used , sometimes by accident, sometimes by necessity . Though, the form , format and content of checklists have evolved in these domains, the tool has made a lasting impact. Basically if you look at all the places where checklists are used, they started as a means to overcome fallibility of human memory and attention , when it comes to mundane and routine matters. Slowly the checklists were adapted to the situation and communication mechanism was put in place to make it work. In essence, any system driven problem solving might need a checklist in its tool kit.

In the construction industry where the very activity of project involves a multitude of tasks at varying complexity levels, there is a heavy use of checklists in various forms, routine task list, exception list, etc. An industry which was characterized by compartmentalized work culture of design-implementation has been replaced by more wisdom of crowds thinking .A single overarching design is not meeting the trying demands of a multi-storied structure. Construction industry has thus seen an end to the master builder culture and has taken a systems approach to design + implementation.

In the airlines industry, checklists are heavily used to handle various situations and remove mental hijack when there is a panic. By laying down the procedures for emergencies, the airlines makes sure that crew does not forget to do some of the basic steps of an emergency. Did you know that the pilot for the airbus that averted the accident, which was called miracle on Hudson and was covered in the media for days and weeks , had used checklists and his crew were well trained to handle such situations. Even though the media portrayed it as an incident where a single pilot had a great role to play, a little investigation by the author revealed a different story, LUCK + Preparedness(checklists) was behind the Miracle on Hudson.

In the field of hotel management, one of the finest kitchens in the world use and communicate using checklists. Sometimes the staff go to an extent of keeping a checklist for each of its valuable customer to give the same consistent experience time and again.

There are a few examples of investors , venture capitalists who use checklists in their work to finalize a deal. There is a mention of Pabrai Investment Funds California, Acquamarine capital management in Zurich who diligently use checklists. Now one can dismiss them as freak examples.

So, if there are so many areas where checklists are used, why hasn’t been an adoption amongst various fields/people ? In the words of the author,

“We don’t like checklists. They can be painstaking. They are not much fun. But I don’t think the issue here is mere laziness. There’s something deeper, more visceral going on when people walk away from not only saving lives but from making money. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply help beliefs about how the truly great amongst us – those we aspire to be – handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. May be our ideas of heroism needs updating

The fear people have about the idea of adherence to protocol is rigidity. They imagine mindless automatons, heads down in a checklist, incapable of looking out of their windshield and coping with the real world in front of them. But what you find when a checklist is well made, is exactly the opposite. The checklist gets the dumb stuff out of the way , the routines your brain shouldn’t have to occupy itself with.”


image Takeaway :

Making a checklist and adhering to it enforces discipline, and reduced human fallibility. I think it is a good quantification mechanism where you can see what’s done, what needs to be done and where you stand.