Check Your List

I read The Checklist Manifesto a few days ago. It only took one sitting. Great book. Every project manager should read this book. Follow a checklist to implement your tasks and you have a reasonable chance at success. Skip the list and you will screw up — no matter how smart you think you are, no matter how much training you’ve had, no matter how easy your task appears to be. That’s the core message of the book — absolutely everyone messes up the things they think they’ve mastered. Even if these mistakes are small they add up to big consequences. And if you happen to work in a field where lives are at risk — construction, aviation, medicine — then people will die because of your mistakes. The science on this is persuasive to say the least, and Atul Gawande documents everything in great detail in a series of extremely interesting stories.

There is a disturbing part of the book, though. It’s the realization that the medical industry is really quite backward and immature in some critical ways. We think of medicine — especially technology-based emergency medicine in the United States — as the most advanced field on the planet. So many people are saved from life-threatening situation and we see this on our television screens every day. Yet the medical community also kills thousands of people due to totally preventable errors. Why? Arrogance.

To drag medicine out of the dark ages and help improve the safety and efficacy of medical procedures, Gawande looks outside his paradigm and explores the construction and aviation industries. Both aviation and construction realized long ago they needed to grow out of their go-it-alone individualism, that the level of complexity simply surpassed the capacity of any one individual to know and implement all parts of a process. Thus, they took more of a team approach, more of a systems approach, more of an approach based on checking lists. Medicine, however, still struggles with this concept in far too many areas. And to be honest, I find that unacceptable. Unfortunately, the era of the doctor as the all-knowing God dictating reality to everyone else is still very much alive and that’s pervasive throughout Gawande’s book. “I don’t have time for a damn checklist, get out of my operating room,” a surgeon would say. Right. Yet when other docs implement Gawande’s checklist lives are saved. So much for the so-called Gods. Get a clue, guys. You’re human. And you’re directly responsible for saving people. And killing them. Which would you prefer?

So, make a list. Use it. Test it. Repeat. Don’t be afraid to be different. That’s the only way things change.

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