red Checklist Manifesto book cover and an illustration of Atul Gawande's headshot

How to make a great checklist

No matter how expert you are, a simple, carefully-constructed list will improve the quality of your output.

That’s the central point that author Atul Gawande made back in 2009 in his popular business book The Checklist Manifesto, which followed an article he wrote for the New Yorker. It’s a short book that others have recommended to me before, so I finally grabbed a copy and breezed through it. His central point is clear enough that it likely could have remained a longform article, but the book is easy enough a read that’s worth the time. If you haven’t already give it a try.

Below find my notes from the book, including tips for making a better checklist yourself.

As always, these notes are primarily for me to return to in the future but I share them here just to give a sense so you might buy the book yourself. Here are my notes:

  • The difference between ignorance and ineptitude: the world of specialization and complexity goes beyond human memory and makes necessary a tool like  the simple checklist in serious places.
  • October 30,1935: Boeing crash of what would become B-17 led to a pilot’s checklist since it was “more airplane than one man could fly”. 
  • The author argues much of what we do today is at B-17 levels
  • A good checklist fits on an index card.
  • John Hopkins Pronovost checklist for the simple medical procedure of line insertions saved eight lives and $2m in costs in 18 months at one hospital.
  • He describes a checklist as a “cognitive net” 
  • Note the difference between simple (baking a cake), complicated (rocketry) and complex (child rearing) processes  
  • Checklists work well both for individual tasks and inter team communication 
  • Over time, the building trades removed the traditional role of master builder for large-scale commercial projects with a cross-team meeting attended by a dozen specified trades and architecture and engineering leads; Government inspectors can’t inspect everything that goes into commercial properties and other large developments so they have developers and their teams sign affidavits attesting to adhering to policy. The at-home DIYer is seen as more dangerous than skyscrapers (the Citicorp Building in the 1970s seen as both a sign of it working, and not) 
  • A Johns Hopkins study showed that surgical teams that knew each other’s names communicated better in surgery

To make a good checklist:

  1. Find a pause point or clear reason someone would review a checklist.
  2. Decide if it’s a DO-CONFIRM (do tasks and then check you have done them all) or a READ-DO (like a recipe) 
  3. At most, it should have 5-9 items, fit it on an index card or small sheet of paper
  4. Takes 60-90 seconds to complete
  5. Only the “killer items” or those that are highly important most likely to be skipped
  6. Written/printed and clearly displayed 
  7. Habit forming 
  8. Must be tested and improved in real world circumstances 

Other notes from the book:

  • Author was inspired by Boeing’s Dan Boorman
  • Depending on the situation, the checklist doesn’t have to be written down and read; it can be verbally read aloud (like surgery checklist)
  • “A checklist is not a comprehensive how to guide “ but a tool to “buttress the skills of expert professionals”
  • WHO safe surgery checklist was a major international project
  • Checklists run counter to many maverick specialists (aviation test pilots to surgeons but these are becoming ever safer and more routine)
  • “We should be ready to accept the virtues of regimentation” 
  • Look at your failures and find patterns you want to correct, help with a checklist 
  • Surgery teams introduce themselves as part of their checklist 

A few points I asked myself: What would a news article look like? What would a leadership team IDS checklist look like? What would a client services call checklist be?

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