The Checklist Manifesto by Atul Gawande [Book Summary]


Visualize being getting treatment for a heart attack during the 1950s. Medical understanding of the reason for heart issue was really scarce during that time that you’d basically be prescribed pain relief and bed rest. Oh, and if you wished to smoke cigarettes during your recovery, that was totally okay as well.

Luckily, human understanding has really improved since then. As small as the past 60 years, doctors were quite inexperienced about treating heart attacks; however, nowadays we have various techniques of doing so, as well as blood pressure drugs, cardiac catheters, and also open-heart surgery. Also, we have a full host of methods to prevent heart issues in the first place, like cholesterol-lowering drugs and more exercise.

But, in difficult fields such as medicine, our wide understanding base has to turn into a double-edged sword. As stated by the World Health Organization, we now have more than 13,000 defined syndromes, illnesses, and injuries. Include the thousands of medications and measures available to treat patients to that and we realize that not a single doctor or medical team can probably learn the entire medical understanding we have gathered.

This leaves us with an issue of ineptitude. Meaning, we are finding it hard to constantly remember, organize and use the appropriate understanding in the appropriate manner. Surgeons and nurses similar are under huge pressure to learn the newest medical technology, handle several patients all at once, and do the huge number of steps required to perform difficult medical procedures with precision. While doing this, at the same time they have to deal with the unforeseen reactions and results that happen when handling people that are sick.

Definitely a new type of tool is required if we are to utilize our huge medical understanding and prevent likely deadly human mistakes.


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Chapter 1 – Checklists help hinder severe; however, easily avoidable errors.


In San Francisco, an operating theater team encountered terrible situations when treating a man for what they believed was a shallow stab wound. It was just after a surgeon’s cut when the patient began spilling out lots of amounts of blood, that they realized the injury measured a foot long. It was, as a matter of fact, a bayonet wound the man had gotten at a Halloween costume party. Unluckily, before the surgery began, none of the medical staff had thought to ask what type of weapon was used in the stabbing.

Although, the man survived the injury; but, errors and misinformation in medicine occur with terrifying regularity and can lead to severe difficulties or deaths. In the United States, more than fifty million surgeries are done every year, and over 150,000 of these patients die after their surgery. From various studies, about half of these complications and deaths are preventable.



Therefore, how can we minimize the number of errors being made?

Instead of spending millions on the newest medical technology, the solution is much easier: use a checklist.

Checklists are as easy as they sound which is a list of steps to be done when doing a procedure. Remarkably, it is the clear steps –things that everybody should know – that are usually the most important and still not remembered or skipped. The checklist serves as a safety net to ensure we get the simple stuff, like asking, “What type of weapon was used?” before we continue any further. As soon as the simple stuff is checked off, we are better prepared mentally to deal with the more difficult or unpredictable problems that are exceptional to each patient.

If a checklist had been utilized in the previously mentioned bayonet injury case, the medical team would have been better equipped for any terrible, bloody surprises.


Chapter 2 – Checklists have to be as short as possible, comprising every important step and leave no space for confusion.


It’s very easy to laugh at checklists, specifically as a lot of us would see them as scrawled reminders or glorified to-do lists. But, when they have all the important steps and are brief and usable, checklists become powerful tools.

One significant part of a checklist is that it has the “killer items” of the procedure. These are the steps that are simply overlooked; however, if not done, it could be terrible. For instance, this could be a reminder to know a patient’s allergies before the surgery.

Though they have to comprise every significant item, checklists don’t need to be detailed guides. A veteran pilot named Daniel Boorman who forms aviation checklists for Boeing, mentions that about five to nine items are ultimate, and there has to be a time limit on how long it takes to go check the list. After about a minute of reading a list, people can get distracted and jump the important steps.



Also, a checklist has to be user-friendly. When carrying out the first thing of his checklist, the author-and-surgeon Atul Gawande confused a nurse in his team just before a surgical procedure since it wasn’t clear how the checklist should be utilized. The nurse had checked off the steps for the procedure before it had even begun, instead of– as Gawande had planned – reading out every step to the surgical team and checking them off as they proceeded.

In order to avoid misunderstanding, it has to be clear if the list is a “READ–DO” (read out the step, then finish it) or a “DO–CONFIRM” (finish the step, then confirm you have finished it). Also, lists have to be written in the language users are known with; for instance, “fire mushrooms” (which means “cook the mushrooms now”) in a restaurant.

When next you make a checklist, watch out to make sure it is accurate, user-friendly and contains just items of the utmost significance.


Chapter 3 – Present’s difficult tasks can no longer be abandoned to a single hero’s expertise; we require teams.


We usually wish for a hero to walk into terrifying circumstances and, using a lifetime of skill and experience, fix the entire issues in one fell swoop. The notion that a lone person’s expertise is adequate to fix our issues is definitely appealing. However, it is also wrong.

In difficult and risky circumstances, it is the team that actually matters.

There used to be a time in engineering when buildings were built by master builders who directed the entire project.  But, nowadays, the finishing of one construction project needs collaboration between professionals who handle everything like mechanics, rodent control masonry and waterproofing

Teams are particularly needed when handling emergencies and crucial circumstances. After the Hudson River plane crash in 2009, the media willingly acknowledged Chesley B. Sullenberger as “Captain America” – the hero of the incredible crash-landing where no one died. Stil Sullenberger claimed that it was a team effort. As the detail on the accident came through, it was obvious the plane wouldn’t have landed as safely the way he did without the joint work of Sullenberger, Jeffrey Skiles the first officer and the remaining of the crew.



In medicine, as well, patients going through an operation need more than only a surgeon. Anesthetists, surgeons, and nurses need to all work together and make use of their unique specialties as a team to do a procedure successfully

When we are confronted with pressure or difficulty, we need to admit that it is usually the actions and expertise of many, as opposed to those of one person, that makes a difficult procedure successful.


Chapter 4 – Team communication is important in complex circumstances and can be extremely improved by a checklist.


Think of a flight crew landing a plane. Now imagine how terrible it would be in this complex, intense circumstance if they could not communicate with one another: the captain would not have recognized if it was safe to land, the co-pilot would not have known when or if they should take the controls, and flight attendants wouldn’t have known when to do safety checks.

Teams working on complex works require unified communication. In the previous case, the flight crew could have a checklist to abide by; however, except they communicate clearly, that checklist is pointless.

Communication can be improved by including steps within a checklist that are intended at enhancing the flow of information. For instance,  a structural engineer in Boston named Joe Salvia makes use of “submittal” checklists describing when teams in charge of construction should update, check on and work with each other before moving on to the next stage.



A team “huddle” is another checklist step that can increase communication is– a chance at the beginning of a procedure for members of a team to introduce themselves and talk about any possible problems. Various studies have revealed that people who are not familiar with each other’s names do not work together as well as those who do know each other names. Due to that, a huddle was added as a compulsory step in the author’s Safe Surgery Saves Lives program checklist. This more communicative method of teamwork was associated with a decrease in medical complications.

Communication within teams is significant in pressured situations. Teams are likely to be more successful at abiding by procedure checklists when they have defined opportunities to communicate.


Chapter 5 – Medical checklists have saved a lot of people already.


It’s difficult to think that a basic checklist could have a huge impact on the world. Still, medical programs studying the use of checklists have revealed that they have prevented errors, saved cost and – most significantly– saved people.

A study conducted by Peter Pronovost a critical care specialist, known as the Keystone Initiative, targeted to minimize the number of infections from central line catheters inserted into the veins of intensive care patients. Central lines are really easy and usually infected (for instance, being touched with unsterilized hands), leading to possibly fatal complications for patients. Pronovost used a checklist to determine if it would minimize infections. It was a success; the initiative eventually saved $175 million and 1,500 lives in 18 months.



Taking inspiration from Pronovost and the fields of engineering and aviation, the author, as well as the World Health Organization, created a checklist to be tried in eight hospitals across the globe, in what was called the Safe Surgery Saves Lives program. The hospitals were told to make use of this surgical checklist, which was made up of nineteen vital items such as talking about the patient’s expected blood loss and checking that they truly had the right patient. The outcomes were surprising; deaths from surgeries across the eight hospitals were minimized by 47%.

Also, the author saw the power of the checklist directly. While going through a surgical check concerning expected blood loss, it turned out that additional units of blood had not been kept aside for the patient should in case they were required. Gawande didn’t think that it would be necessary for the patient; however, abiding by the checklist, more blood was prepared. While in the surgery, Gawande did an accidental tear leading to cardiac arrest in the patient. The additional blood was eventually useful and Gawande is certain that without the checklist, the patient would have been killed by him.

Making a simple checklist is not just a powerful tool; however, it may also signify the difference between life and death.


Chapter 6 – Checklists can be useful in various environments.


A lot of us work in difficult or high-pressure surroundings that, such as the field of medicine, need care and precision, like in finance or the restaurant industry. But, the good news is that, in such extreme surroundings, checklists truly make a difference in assisting us to work more productively.

Consider, for example, chef Jody Adams at Rialto Restaurant in Boston. The checklists Jody makes use of are what most would refer to as recipes. Still recipes and checklists share the same purpose: they show us what has to be completed and when. Additionally to having her recipes on show at her kitchen workstations, the restaurant staff as well creates checklists to make sure that the special needs of every customer are met. 

As soon as the dishes are prepared to be served, they get the last check by the sous chef or Jody herself to ensure that they meet Jody’s criteria. This checklist system allows Rialto to give exquisite dishes to customers all the time, and no wonder Jody has won awards for her skill or that the restaurant usually gets to the “best restaurant” lists.



Financiers, as well, can make use of checklists to assist them to prevent avoidable risk due to reckless or uninformed choices. “Cook,” an anonymous investor and manager of a fund value billions of dollars, makes use of a “Day Three Checklist,” which assists him and his team choose whether or not to invest in a company. The checklist provides Cook a big edge: efficiency. This careful and fast approach for evaluating investments offers him an advantage over other investors.

From making sure of high-quality dining experiences to assisting rake in the big bucks, an ordinary checklist is a useful tool that can produce remarkable outcomes and be used to various different circumstances.


The Checklist Manifesto: How to Get Things Right by Atul Gawande Book Review


More than a to-do list for the incompetent, a checklist can be an extremely useful tool for professionals and experts. Making use of a well-crafted checklist in difficult circumstances guarantees we see possible fatal mistakes and dangerous errors.


Are you still having mistakes in your tasks, in spite of your experience and expertise? Make use of a checklist!

We can become stubborn when we talk about creating checklists for ourselves, particularly when we know precisely what we are doing. But, it is usually the experienced professions that gain the most from having a checklist. One of the causes for this is that we usually skip or forget the noticeable “dumb stuff,” incorrectly assuming that concentrating more complicated things is far more significant. But, the dumb stuff is usually significant to the procedure at hand. Making use of a checklist assists you evade allowing the essential thing to slip through the cracks, and you might just see that you make far fewer mistakes because of it.

Need assistance with team projects at work? Try a checklist “huddle.”

When staring a team project, ensuring that the entire team knows the name and duty of every person in the project will assist communication and information flow very easily. Take time at the beginning of every project or procedure for a team huddle: make everybody introduce themselves and their duty, and have the crucial members share their prospects and any possible difficulties that may be met along the way.


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Savaş Ateş

I'm a software engineer. I like reading books and writing summaries. I like to play soccer too :) Good Reads Profile: https://www.goodreads.com/user/show/106467014-sava-ate

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