Book - The Checklist Manifesto

Table of Contents

1-Sentence-Summary

The Checklist Manifesto explains why checklists can save lives and teaches you how to implement them correctly.

Under conditions of complexity, not only are checklists a help, they are required for success.

Summary

Checklists save lives, especially in highly complex fields. With the enormity of what we know and can do, no individual or team can possibly remember everything. Implementing a checklist ensures that professionals don’t forget the easily missed, yet critical items. The Checklist Manifesto: How to Get Things Right will teach you the why and how of using checklists.

Lessons

Here are the 3 greatest lessons this book teaches about checklists:

  1. Using a checklist will help you avoid common mistakes with serious consequences.
  2. Make your checklists short, clear, and focused on the essentials.
  3. There are various applications for checklists in whatever occupation you have.

Lesson 1: You will avoid serious mistakes by implementing a checklist.

If you were receiving treatment for a heart attack in the 1950s, you may have only had to take meds and be on bed rest. But today there are multiple ways of treating a heart attack and we can even prevent them, too. While we are saving lives, this advancement comes with a cost. The added complexity makes it more difficult for professionals of any kind to make the right decisions consistently

I began my career as a Civil Engineer. In this field, there are numerous code requirements to remember. For the work I do, as many as six different codes, with hundreds of pages each may apply on just one job. I found that with so much to remember, it was difficult to catch each thing that I needed to do on each job. This problem isn’t one that only Civil Engineers have. Multiple fields of work have a hard time remembering, organizing, and applying the correct know-how in the correct way.

The solution to all of these problems is to use a checklist. Though simple, checklists are powerful tools to list all the steps necessary to complete a procedure. They contain the most commonly skipped requirements for accomplishing a complex task. In this way, checklists act as a safety net to make sure we don’t miss what seems obvious.

Lesson 2: Focus on the essentials and be short and clear when creating checklists.

I love writing spreadsheets. Financial-planning, goal-setting, habit-tracking, and numerous other kinds of in-depth spreadsheets litter my Google Drive right now. If it were up to me to write a checklist for everything I do, I would likely make it too complex. But the power of checklists comes in their being concise, focused only on what’s essential.

When creating a checklist, your goal is not to write an in-depth guide. Rather, focus on the vital few things that you or your team must complete to do the procedure correctly. Think of the items that you may have commonly missed in the past and be sure to include them. You only need five to nine items on a checklist for it to be effective. Most people easily become distracted after about a minute of reading a list, so keeping it short will help you stay focused.

Also make sure that the application of your checklist is clear to those who will be using it. There are two kinds of checklists:

  • “READ-DO” checklists are the kind where you read the step first then complete it.
  • “DO-CONFIRM” checklists are used by finishing each step then confirming it’s done.

Knowing which type you’re using is vital to the successful application of checklists.

Lesson 3: Whether you are a chef or a stock market investor, checklists will help you become more effective.

It’s easy to see the usefulness of checklists in the medical field, or even engineering. But don’t discount their power to help your team, or even you as an individual, become more effective. No matter what type of intense environment you work in, using a checklist will help you be better at what you do.

Chef Jody Adams, for example, uses checklists at the Rialto Restaurant in Boston to help her know what to do and when. Using checklists for recipes and special customer requests allow Adams to consistently serve exquisite meals to customers. Her efforts have led to many awards and placements on “best-restaurant” lists.

Using a similar process of writing down patterns to help people make decisions also benefits stock market investors. One anonymous investor who goes by the name of “Cook” uses a checklist to help his team determine if they will invest in a stock. Because of the added efficiency this system brings, Cook has a leg up on the competition. He and his team couldn’t evaluate potential investments so quickly if it weren’t for a checklist.

The Book in Three Sentences

  1. Checklists protect us against failure.
  2. Checklists establish a higher standard of baseline performance.
  3. In the end, a checklist is only an aid. If it doesn’t aid, it’s not right.

The Five Big Ideas

  1. Checklists are required for success.
  2. When doctors and nurses in the ICU create their own checklists for what they think should be done each day, the consistency of care improves to the point where the average length of patient stay in intensive care dropped by half.
  3. The three different kinds of problem in the world are the simple, the complicated, and the complex.
  4. Checklists can either be DO-CONFIRM or READ-DO (see below for a description) and must be kept between 5-9 items.
  5. The wording of a checklist should be simple and exact and fit on one page.

The Checklist Manifesto Summary

  1. 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.

  2. Whether running to the store to buy ingredients for a cake, preparing an airplane for takeoff, or evaluating a sick person in the hospital, if you miss just one key thing, you might as well not have made the effort at all.

  3. A further difficulty, just as insidious, is that people can lull themselves into skipping steps even when they remember them.

  4. Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance.

  5. The researchers found that simply having the doctors and nurses in the ICU create their own checklists for what they thought should be done each day improved the consistency of care to the point that the average length of patient stay in intensive care dropped by half.

  6. Pronovost found checklists established a higher standard of baseline performance.

  7. Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized.

  8. Three different kinds of problems in the world: the simple, the complicated, and the complex.

  9. The philosophy is that you push the power of decision-making out to the periphery and away from the center. You give people the room to adapt, based on their experience and expertise. All you ask is that they talk to one another and take responsibility. That is what works.

  10. Under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided—and even enhanced—by procedure.

  11. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an ‘activation phenomenon.’ Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up.

  12. When you’re making a checklist, you have a number of key decisions. You must define a clear pause point at which the checklist is supposed to be used (unless the moment is obvious, like when a warning light goes on or an engine fails). You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist. With a DO-CONFIRM checklist, he said, team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off—it’s more like a recipe. So for any new checklist created from scratch, you have to pick the type that makes the most sense for the situation.

  13. The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory.

  14. The wording should be simple and exact, Boorman went on, and use the familiar language of the profession. Even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colors. It should use both uppercase and lowercase text for ease of reading.

  15. It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals.

  16. Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.

  17. In the end, a checklist is only an aid. If it doesn’t aid, it’s not right. But if it does, we must be ready to embrace the possibility.

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