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What is it about?

The author’s key message is that the volume and complexity of knowledge today has exceeded any single individual’s ability to manage it consistently without error despite material advances in technology, boatloads of more training and super-specialization of functions and responsibilities. Yet, despite demonstrating that checklists produce results, there is resistance to their use because of the

  • Master of Universe mentality (Rock Star; Fighter Pilot; Hero),
  • our jobs are too complex to reduce to a checklist,
  • checklists are too rigid and don’t force us to look up and see and think ahead of what’s in front of us.

Yet, in a complex environment, he states that experts are up against 2 difficulties – the fallibility of human memory when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events and secondly, people can lull themselves into skipping steps even when they remember them – after all certain steps don’t always matter…until one day they do. Gawande makes a persuasive case in his book as to why you should develop and implement a process checklist for critical processes/decisions.

D. Kanigan, a review on Amazon.com

What does this mean to managers like me?

Management theory gives us the Deming Cycle; “Plan, Do, Study, Act” which is the foundation of many Continual Improvement strategies. It is no coincidence that the Deming Cycle and “Lean” is most effectively practiced in engineering. The engineering profession is subject to almost perfect competition and customers buy the most efficiently produced products that are safe to use. Ineffective and dangerous suppliers simply go bust (and vote Trump/Brexit/Le Pen etc). This provides a strong incentive for management and workers to serve the customer better.

The challenge managers face is how to implement continual improvement at scale in industries such as medicine and education that have very weak competition and no existential incentive to change. Fortunately within every institution there are innovators and early adopters who have the enthusiasm and capability to improve the art. We must support them and then disseminate their results to the rest of the community.

  • I think that the one-page, 9 item checklist could be the mechanism by which continual improvement is delivered

Next steps

I strongly recommend that you read The Checklist Manifesto: How to Get Things Right. Atul Gawande. (Amazon)

If you do then please do add your comments to this post as I would greatly value your opinion.