The Checklist Manifesto: How to Get Things Right

The Checklist Manifesto may look like yet another self-help or productivity book. But I found it to be a well-written book on the power of the humble checklist.

Its author, Atul Gawande, is a surgeon who has helped to create a checklist now used by hospitals worldwide. When hospitals began using the checklist, they reduced deaths and major complications during surgery by more than 30% (wow!)

The checklist itself is simple, only covering the most important steps during a surgery. Think things like confirming a patient's identity, or making sure they've received antibiotics. These key steps might _seem_ trivial, but on average, one of these steps was missed in two thirds of surgery patients.

In the book, Gawande also takes the time to explore how other industries use checklists, for flying planes, building skyscrapers or running investment firms. Altogether, he made a pretty compelling case for the power of checklists.

The 3 steps to implementing a successful checklist

1. Keep the checklists usable. In a high-stakes situation like surgery or flying an airplane, you want to keep your checklists brief and to the point. Only cover the most important tasks. If you miss these tasks, they could cause major or fatal consequences. This also ensures that people will actually _use_ the checklist and follow all the steps.

2. Have the checklists broken down into subsections, to occur before key trigger points. In a surgery, that might be right before you give a patient anaesthesia, or the moment before the first incision. Breaking it down makes it less overwhelming, and a trigger makes it easier to remember when to do a checklist.

3. Test the checklist, and refine it. A checklist is never going to be right on the first go. Through many iterations, you’ll be able to amend the bits that are confusing, or add and remove sections as needed.

How developers can use checklists

The book proves that checklists work in medicine and other industries, but what about for developers? A developer’s checklist could include things like:

* Writing test notes before a task, or talking through your approach with the stakeholder or another developer. This way, you can make sure that all your assumptions are correct.

* Making sure all tests pass before raising a pull request.

* Showing your work to another developer before letting the code hit production, to double-check for bugs.

It might seem silly to have such a checklist, but the idea here is to keep the tasks simple. If you miss them (and let’s face it, sometimes we do) they could have big consequences. Misunderstanding a requirement from a stakeholder could force you to rewrite part of your code. And if you shipped a bug to production you could have some angry customers on your hands.

Conclusion

The Checklist Manifesto was a fun read, with lots of interesting examples of how different industries are using checklists. Among the many productivity books I've read over the years, this one is up there! I can definitely see the value this could add to my own life - I just need to figure out what these checklists could look like.

The book's title makes it come across like just another self-help/productivity book but the author has some really strong credentials. He's a doctor who has worked with WHO to implement a checklist system now used by hospitals worldwide, that reduced complication/death rates by huge amounts (like 30-50%).

The author uses examples from his own field (medicine) but has also taken the time to interview a guy from Boeing who writes checklists for pilots, a busy restaurant owner and a building manager who is in charge of building skyscrapers (who all use checklists successfully).

He raises some really strong evidence for using checklists. The reader would have to go away and think about how it can be applied to their own workplace (he never talks about how it could be applied outside of a work environment, but there is probably some value there too!)

The main concepts are simple enough to grasp:

* Write checklists to cover major points, but short enough that they only take a minute to do
* Have the checklists broken down to occur before key trigger points (e.g. one checklist right before surgery incision, one for right before you take the patient out of the operating theatre)
* Test these checklists, and constantly refine them as you go. A checklist that works for one hospital might not work exactly the same for another but that's okay, you can modify them
* If you're in a team-based setting, take a minute before beginning to go around and introduce yourselves, and to raise any concerns/thoughts you may have. This gives nurses the opportunity to voice their thoughts which they might not otherwise feel they have the authority to do.