By Adamu Tilde
Checklist. Noun. A list of tasks to be completed, names to be consulted, conditions to be verified.
Dr. Atul Gawande introduced the book with a philosophical concept of “necessary fallibility” developed by Samuel Gorovitz and Alasdair MacIntyre in the 1970s. Why we fail at what we set out to do in the world, asked Gorovitz and MacIntyre.
Two reasons explained our failure, argued Gorivitz and MacIntyre: Ignorance and ineptitude. We may err because science has given us only a partial understanding of the world and how it works. There are skyscrapers we do not yet understand how to build, snowstorms we cannot predict, heart attacks we still haven’t learned how to stop. Even enhanced by technology, our physical and mental powers are limited. Much of the world and universe is– and will remain– outside our understanding. That’s ignorance. Ineptitude on the other hand is when the knowledge in the aforementioned instances exist, yet we fail to apply it correctly.
Getting the steps right is proving brutally hard, even if you know them, argued Dr. Atul Gewande. Know-how and sophistication have increased remarkably across almost all our realms of endeavor, and as a result, so has our struggle to deliver them. Failure of ignorance can be forgiven. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated. It is not clear how we could produce substantially more expertise than we already have. Yet our failures remain frequent. In other words, knowledge has both saved us and burdened us.
What this means is that we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy– though it will seem almost ridiculous in its simplicity, maybe even crazy to those who have spent years carefully developing ever more advanced skills and technologies.
What do you do when expertise isn’t enough?
It is a checklist.
Checklist came into being from an unlikely place: the US Army Air Corps. In 1935, the US Army held a flight competition for airplane manufacturers vying to build the military’s next-generation long-range bomber. Boeing Corporation’s Model 299 was the favorite. Unfortunately, model 299 crashed in a fiery explosion. An investigation revealed that nothing mechanical had gone wrong. The army still went ahead and purchased a few aircraft from Boeing. They did not require Model 299 pilots to undergo longer training. Instead, they came up with an ingeniously simple approach: they created a pilot’s checklist.
Checklists are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of experts and professionals. Substantial parts of what software designers, financial managers, firefighters, police officers, lawyers, and clinicians do are now too complex for them to carry out reliably from memory alone.
A quick caveat: Checklist isn’t a magic wand. Checklist works where there is required expertise, training, and experience. It only helps in keeping the fallible expert in check, so as not to forget to do the right thing. Memory and judgment are unreliable. Checklists are reminders of only the most critical steps.
In a historic research led by the author in eight different hospitals around the world, the introduction of a checklist to the Operating Rooms resulted in 36% fall in major surgical complications. Deaths as a result of infection, bleeding and other technical problems fell by 47%.
The shrewd investor and one of the richest men in the world, Warren Buffet, make use of a checklist to make decision. Even in kitchen, one of the most particularized and craft-driven enterprises, checklists are required. Everywhere you looked, the evidence seemed to point to the same conclusion. There seemed no field or profession where checklists might not help. And that might even include your own.
In the late part of 2020, I bought a couple of thousands of adult birds. There was not much due diligence on my part so I suffered some losses. In January 2021 my brother, Barr Kabiru A Garkuwa, gave me Gawande’s The Checklist Manifesto. I interrogated my previous poor decision and developed a checklist after reading it. My checklist contains ten conditions a bird must satisfy before I buy it. A checklist can be deployed in almost every circumstance. In choosing spouse(s). In buying land or car. In election of leaders. The Checklist Manifesto is unputdownable. I strongly recommend it to anyone interested in improving performance and instilling discipline.
In conclusion, discipline is hard – harder than trustworthiness and skill. We are by nature flawed and inconstant creature. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at. And this is what Checklist would help you achieve. 2/
PS
Dr. Atul Gewande is a general surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. He is the author of the international bestseller Being Mortal: Illness, Medicine, and What Matters in the End; Better: a Surgeon’s Note on Performance; and Complications: a Surgeon’s Note on an Imperfect Science.
