The checklist

Before I started on this piece, I thought it would increase the randomness quotient on Not Too Random. But once I actually got down to writing, it struck me that what I’m writing about, though linked to the practice of medicine, is something that can be used almost anywhere and by anyone. It is about a simple method to get things right — using a checklist. And that certainly is not too random.

I discovered Atul Gawande’s work a couple of years ago. Gopal Raj, a friend and former colleague, lent me Gawande’s second book, Better: A Surgeon’s Notes On Performance. I read it and was hooked.

Soon after, I read Gawande’s first book, Complications: A Surgeon’s Notes On An Imperfect Science and stayed hooked. Though slightly rawer than Better, Complications was equally fascinating.

Gawande, a practising surgeon, writes about serious stuff, but is a quintessential storyteller. His writing is thoughtful, easy, laced with humour and colour; it slowly reels the reader in and then keeps her interested. But what really makes his work stand out is the candour he brings to the table.

He asks questions — often, uncomfortable ones — about ethical and performance issues that underlie the practice of medicine. Questions that few medical practitioners would be willing to articulate in public. He’s also refreshingly honest about mistakes, his own and those of others. All as part of his quest to create a better understanding of the intricacies of modern medical science. And, perhaps, through this understanding help medicine get better at doing what it is meant to — help people stay healthy.

And that’s part of what Gawande sets out to do in his latest book The Checklist Manifesto. While the book springs from his experiences as a surgeon and his desire to improve surgical performance, it moves pretty quickly on to a macro issue: How do professionals deal with the growing complexity of their jobs.

Searching for the answer, Gawande talks to surgeons and pilots, financiers and the master builders who erect skyscrapers. And the answer, it seems, is to use a humble checklist — simple, crisp, written guides that walk people through the key steps in any complex task.

Of course, the checklists that experts use to address complexity in their professions are not the ordinary ‘to-do’ lists that many of us use. But they are based on the same idea — an aide memoir to ensure completeness in carrying out a task.

Once he freezes on the checklist as the tool to handle complexity, Gawande and a team of researchers work with the World Health Organisation to develop a Safe Surgery Checklist. One that can be used by hospitals across the world. Almost simultaneously, though, Gawande discovers that getting people to adopt a checklist — in medicine or in finance for that matter — is not a very easy task. Pilots, it seems are the only exception; the one profession in which checklists are adhered to, no questions asked.

Gawande, though, has no doubts. Towards the end of the book, he writes:

“Indeed, against the complexity of the world we must. There is no other choice. When we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination… It’s time to try something else. Try a checklist.”