Using lists to help firms avoid disaster

The Checklist


How to Get Things Right

Atul Gawande


Metropolitan Books: 224 pp., $24.50

A recent study in the journal Science showed that rats stop thinking and resort to habit when they are under extreme stress. Humans might well do the same.

Nonetheless, we appear to believe that in our professional lives, such stress will produce an adrenaline-fueled surge of clear and brilliant thought. It doesn’t. And in the ensuing muddle, mistakes -- sometimes fatal -- are made.

Atul Gawande, a surgeon, Harvard Medical School professor and staff writer for the New Yorker, has written a welcome book to convince us of the distinction between unavoidable failures and those we can avert.


“The Checklist Manifesto” is a slim volume but it is packed with vivid writing, heart-stopping anecdotes and statistical surprises.

This is Gawande’s third book, but his first aimed at a wider business audience than fellow physicians. It draws on a variety of sectors, including finance, architecture and aviation.

Teamwork is the book’s focus and so should appeal to business managers everywhere who are grappling with this thorny subject. As he says, “Man is fallible, but maybe men are less so.”

Gawande argues that simple checklists are the key to preventing small mistakes from becoming a full-scale disaster. The jobs of financial managers, doctors, software engineers and others “are too complex to carry out reliably from memory alone,” he warns.


Checklists are to be deployed as an agent of humility, to lift the illusion of professional omniscience and to inspire teamwork in an era of specialization.

Gawande’s checklists are not scribbled notes but are announced and discussed by everyone in a room. This is no easy task -- it can wound the ego, he admits. Team members can be embarrassed to be seen as pen-wielding automatons, checking up on their peers or questioning authority. Gawande takes pains, as a result, to make checklists unthreatening. They get “the dumb stuff out of the way,” he says.

This solution is so obvious that it seems hokey. But the book scours various industries for examples of professionals who have failed to use a checklist as simple reminders to prevent panicked thoughts from overtaking rational actions. So, Boeing provides a checklist for pilots in crisis, including the simple directive: “Fly the plane.”

In describing what can happen without checklists, Gawande wields a breezy prose and intense curiosity about the subject. He grabs the reader with anecdotes of stomach-churning disaster: simple errors that cause surgeries to fail and aircraft to crash.


Gawande’s treatment of finance is too short, however. He mentions several investors who used checklists to earn outsized returns, notably Mohnish Pabrai, an Irvine investor who saw returns of almost 160% on investments in 2008, using a list of 70 or more items, including reminders to examine footnotes on financial statements. However, the money men overall get less attention compared with those in other professions.

His most searing analysis is from his own field, medicine, where checklist use, he writes, has reduced costs and fatalities. He cites the example of one hospital that believed it saved $2 million, and prevented 43 infections and eight deaths after implementing checklists.

If there is a criticism of this book, it is that it is heavy on anecdote but light on insight.

Some of the author’s best observations are made in passing -- for example, his finding that checklists can get high-powered personalities to function as a close-knit and coherent team. Considering how many managers face this challenge, Gawande would have done well to examine the idea in depth.


Nonetheless, he makes a compelling argument for attention to detail in this age of automation, when so much appears to be done for us.

Moore is a contributor to the Financial Times of London, in which this review first appeared.