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The Alchemy of Leadership Blog

A big tick for checklists

checklist gawande3

This is an important book which is also a bit of a mixed bag. It’s oddly paced. It’s irritating to read. Yet it dispenses fascinating insights.

Oddly paced, because it starts off well, dips in the middle and finishes strongly. Most business books I read tend to start off strongly and then gradually deflate, like a balloon with a slow leak.

Irritating to read, because there is a lot of padding in amongst the good stuff. Well-worn stories retold with a slight twist. Long, involved anecdotes about not-terribly-relevant examples from other walks of life. These include my own field, project engineering. The author discovers that, as well as developing a timeline specifying who does what when, the various people running the project should hold meetings with each other. Well, duh.

Yet dispenses fascinating insights, because Atul Gawande, an American surgeon, seems to have hit upon something very important: that simple checklists can help us fallible humans avoid mistakes and take better decisions, even in such complex areas as venture capital and asset management. Checklists aren’t just for aviation pilots and surgeons.

Live with the pacing, hold the irritation and discard the padding, then, and focus in on the fascinating insights. Checklists really, really work, so long as they’re kept short and simple – anything taking more than two minutes won’t get done. Don’t attempt to cover every single conceivable step with the checklist – focus on critical items that are easily forgotten. And expect to develop lots of specific checklists to cover different situations. One financial investor has developed 70.

The results are astonishing. Having developed a simple surgical checklist under the auspices of the WHO, Gawande reports a reduction in major complications of more than a third, and a near-halving in deaths. These results are achieved in hospitals in countries rich and poor, on different continents, speaking multiple languages. It’s the cheapest and easiest healthcare revolution imaginable.

Except that it turns out it isn’t. Change management challenges are as alive in surgery as in any business endeavour. The author doesn’t use the phrase ‘not invented here’ (NIH) but this seems to be the big barrier to adoption of this simple tool. Persuading the ‘hero’ doctor to following a boring checklist turns out to be much harder than selling her or him a cool new surgical technique.

For an example of a modern-day hero in action, the author turns to the well-known story of Sully Sullenberger and the ditching of United flight 1549 in 2009, the ‘Miracle on the Hudson’. Thanks to the Tom Hanks movie, we all know the details. The use of checklists was fundamental to the pilots’ success in keeping the Airbus 320 flying long enough to ditch successfully. However, Gawande fails to mention the instinctive decision Sullenberger took to turn on the Auxiliary Power Unit (APU). This critical action gave them the power they needed to control the plane – but it wasn’t on the checklist at all. There is still room for improvisation and innovative thinking, even with a checklist.

You can buy the Checklist Manifesto on Amazon.

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