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Book Recommendations

The Checklist Manifesto by Atul Gawande

July 2023
— Reading Time: 3 minutes

I imagine it’s not difficult to guess why I was drawn to this book!  It was recommended to me, and my initial response was ‘you had me at manifesto!’ Yes, the title piqued my interest, but researching further into the work and humanity of American surgeon, Atul Gawande, has been eye-opening and inspiring for me. Atul is the author of four best-selling books, and The Checklist Manifesto published in 2009 is the third of his books.

The premise of this book is that when things matter and we want to get things as right as possible, we should lean on a trusty checklist. Whilst this sounds so simple, to read the medical examples in this book, along with stories from engineering, construction, aviation and more has been most helpful for me, and I have already gone to the trouble of writing several checklists for multi-layered work tasks.

Atul admires the stupendous know-how we now have in the 21st century and the extraordinary accomplishments, but he also notes that avoidable failures are common and persistent across many diverse fields. He suggests the reason is clear: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. ‘Knowledge has both saved us and burdened us.’ Atul’s simple solution is the humble checklist, that builds on experience and takes advantage of the knowledge people have whilst also making up for our inevitable human inadequacies.

Inherently, I think we all know how helpful a checklist can be, but it can be a bit tiresome to write one or to follow one – particularly when we think we have the knowledge. As a trivial example, I don’t write down a checklist when I am just going away for a weekend, but if I was embarking on a major overseas trip, then I would go to the effort to write down a detailed checklist and would then ensure I ticked it all off as I completed my packing.  And guess what?  I often forget one or two things on my weekend trips, and don’t forget anything on my long overseas trips.  Unsurprisingly, checklists work, but we need to be disciplined firstly to develop and then secondly to follow them.

To highlight this point, let’s just take one fascinating example of a checklist being introduced into Intensive Care Units (ICUs) in hospitals. This checklist was just to address one specific ICU problem, that of central line infections. There were five steps to the doctor’s checklist: 1. Wash their hands with soap. 2. Clean the patient’s skin with chlorhexidine antiseptic. 3. Put sterile drapes over the entire patient. 4. Wear a mask, hat, sterile gown, and gloves. 5. Put a sterile dressing over the insertion site once the line is in.  Apparently these five steps have been known and taught for many years, but when nurses were asked to observe doctors using this checklist, they recorded that in more than one third of patients, doctors skipped at least one step. Over the course of the year, in this one hospital, the adherence to this checklist prevented 43 infections, 8 deaths and saved two million dollars in costs!

Whilst the manifestos we help individuals to craft aren’t a checklist, they do often contain critical and vital elements in one’s life that can easily be overlooked within the hustle and bustle. In the same way that a checklist can provide success and minimise errors, we have seen how a personal manifesto can bring clarity and calm to one’s life. Living in alignment with your manifesto leads to success in life, as described and defined by you!

I invite you to consider if there is some aspect of your life – personal or professional – that may benefit from the discipline of writing, and then adhering to, a checklist.  Go well!

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