The Checklist Manifesto

If you go shopping without a list you tend to buy more; you also tend to forget to buy the things that you really need. The worst aspect of leaving your home list-less, however, is the amount of time you waste staring into space while scratching your head as you desperately try to visualise what sent you out shopping in the first place. Now change the venue: imagine you’re a surgeon in the operating theatre. You’re about to do a procedure, but have you forgotten one or two simple but vital steps along the way: Is it the correct patient? Are you cutting off the damaged leg? Have you washed your hands? Have you administered the antibiotics pre-op? So much to remember, but then, you’ve done this a zillion times before so you know it all, or do you…

Atul Gawande was asked by the World Health Organisation to help develop a global program to reduce avoidable deaths and harm from surgery. WHO had found that as the volume of surgery was increasing worldwide, a significant portion of the care was so unsafe as to be a public danger. When Gawande asked how much money was set aside for this project, the answer was: none! Somehow, Gawande was persuaded and in his fascinating book he takes us through a minefield of possible mishaps, from the aviation industry where there is a checklist for every eventuality, to how he comes up with a checklist that the WHO are happy to persuade hospitals around the world to adopt.

"Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realised. They provide a kind of cognitive net. They catch mental flaws inherent in all of us – flaws of memory and attention and thoroughness. And because they do, they raise wide, unexpected possibilities."

This is a book that I would love to send to every hospital manager in the country with an extra copy for the Minister for Health. I am convinced, utterly, that our health service would vastly improve in every area if the ideas put forward by Gawande were adopted in surgeries, operating theatres, out-patient clinics, Accident & Emergency, and with waiting lists. And businesses of every description could also benefit from a more streamlined approach to getting things done.

When you sit down and think about it, a well-constructed checklist of not more than ten steps, could quite possibly revolutionise so many aspect of our lives. Most people think they can hold everything in their heads but what happens when they forget something along the way or when someone else has to take over and do their job.

I often think that a daily checklist would improve my life immensely. It would include the do’s and don’ts that I regularly forget thereby getting myself into all kinds of hot water.

1. Stop saying Yes! - a little reflection could well turn that into a No!
2. Brush the cat
3. Drink water - you wouldn’t believe but I actually forget!
4. Recharge the phone battery
5. Stop making helpful suggestions that involve too much personal input
6. Make sure to have something sprouting: chickpeas, mung beans etc
7. Meditate for 12 minutes
8. Think hard before starting an argument with my progeny
9. Set the DVD recorder before the programme starts
10. Check appointment diary. I once started to leave the house when someone reminded me, with minutes to spare, that I had actually invited ten friends around for a light supper. It was a very light supper!