Atul Gawande writes for The New Yorker, but by trade he‘s a surgeon; after a particularly harrowing operation in which the patient nearly died, he took a hard look at what had gone wrong and he found that a simple error had nearly doomed his patient. Not long after, he happened upon an anecdote that piqued his interest—an account of an Austrian community hospital where a girl had been brought back from apparent brain death due to drowning. Intrigued, he began searching the literature for a confirmation of what had occurred in Austria, and he found it in a Johns Hopkins study detailing a reduction in infections after surgery. They had one factor in common, and that was the use of a checklist.
The Checklist Manifesto is Gawande’s account of this “aha!” moment, and his search—under the auspices of the World Health Organization—to find out if something as simple as a checklist could improve patient survival rates. The quest led him in many different directions, one of which was the obvious idea of trying it out in real-life situations. As he recounts, this was not as easy as it might seem, because surgeons as a rule are confident and headstrong and don’t take kindly to being second-guessed by a sheet of paper. It also led him to the construction industry and the complex process of building a skyscraper. To ensure that tasks get done correctly (and to keep the thing from collapsing), construction engineers use—you guessed it—a checklist. Finally, Gawande gained some priceless insight from the aviation industry.
Unless you avoid newspapers and television, you’ve probably heard of Captain “Sully” Sullenberger, the pilot of US Airways Flight 1549. After taking off from New York City’s LaGuardia Airport on January 15, 2009, the plane struck a flock of geese, unbelievably losing both engines in the process. While he was justly heralded for gliding the airliner to a safe landing in the Hudson, Sullenberger resisted efforts by the press to make him a hero, insisting that it was a team effort. Gawande points out that today’s modern airliner is so incredibly complex that no one person, or even a team of people, can operate one safely on their own; the crew of Flight 1459 relied on a simple tool during their forced landing. That tool is one that has been used by pilots everywhere almost since the dawn of aviation—the checklist.
Atul Gawande’s determined effort to see his theory through is at the heart of The Checklist Manifesto, and its implications are widespread; he shows us a simple tool for complex problems that can be applied to business, government and just about any situation where unanticipated complications can lead to disaster. It remains to be seen whether this surgical Cassandra’s solution will be heeded.
James Neal Webb works for the Vanderbilt University Library.