The Checklist Manifesto by Mr (dr) Atul Gawande. It is surprising that many surgeons like to be called by their names while physicians always prefer Dr!
E book
rating- 4.5/5
Non fiction self help book with special relevance to the field of medicine and surgery but can be applied to every field!
The book starts with two very interesting cases which feel like an episode of Gray’s anatomy but with better ending and more human touch.
After that we get to know that the author is an accomplished surgeon with special interest in cancer surgeries. Then he tells us about the fact that most average patient in the ICU gets so many decisions made which make a big difference to his or her life! There are over 176 or more decisions to be made everyday by everyone in and around that it is mind boggling!
Then he tells about the crux of the matter! The checklist! Imagine how when a patient comes to meet you and in between the talk with the bystanders and other issues, you forget to even check his or her pulse!
That normally does not happen since the measurement of vital signs is a big and important measure in every patient management!
The checklist for health was the vital signs! A blessing in disguise! This simple start actually can make your diagnosis and treatment in most of the times! How medications has to be given to the patient normally depend on a coordination between the nursing staff and this is the backbone of any hospital management!
Like every great and important thing though even the measure of vital signs was not accepted initially but later this simple maneuver had wide acceptance and then revolution!
So in spite of the seriously medical input in the first couple of chapters, the book is actually about increasing efficacy in your professional world!
He tells how the age of specialisation has grown so much that one fine day you would have a doctor who has specialised in the RIGHT ear while another one in the LEFT! You can imagine the same with the eyes!
For now the average Otologist is specialised in both the ears so you are safe!
But this craze for specialisation is well, crazy!
This complex specialisation brings about the very big problem of selection! Atul then tells about this great air competition with Boeing and the US army! One of the airplane was so complex that the pilot just could not handle it and crashed!
This is when the mandatory checklist system was introduced! You must remember that human brain though an amazing creation with amazing power is still mortal! If it has to process too many things then it gets very difficult!
The solution is to have a checklist! Now you have this standard checklist before any flight which is why aviation has become so safe! Everything starts with a simple thing which makes a big change! The first place where the checklist was introduced was the aviation industry and Atul went and met the person responsible for the same! Every cockpit of every flight now has a checklist for each situation! What to do in case of every possible problem and how! If you actually follow the checklist then you have a very high possibility of tackling most problems!
In fact he also gives a couple of great examples for the same! Nail biting by the way! Do not read them if you have a long flight coming up!
The next area where checklists are the backbone is the making or construction industry!
All over you, you can see the concrete jungle! The remarkable thing is that they stand so tall and do not fall! We add somewhere around seventy thousand new commercial buildings and one million new homes each year as mentioned by Atul!
But “building failure” —defined as a partial or full collapse of a functioning structure-is exceedingly rare, especially for skyscrapers. According to a 2003 Ohio State University study, the United States experiences an average of just twenty serious “building failures” per year. That’s an annual avoidable failure rate of less than 0.00002 percent!
And, Atul was explained by his friend that although buildings are now more complex and sophisticated than ever in history, with higher standards expected for everything from earthquake proofing to energy efficiency, they take a third less time to build than before and they are more safe! All because of the checklists made and followed at every stage! With every checklist in place, the whole complex building steadily comes in place and fits together like a jigsaw puzzle!
The next place he tells about the checklist involved the emergency management done by walmart. How this private company took the initiative when the government was locked in red tape! How the civic authorities failed miserably even though they had the resources but lacked coordination! While Walmart with their own checklists and protocols showed the way and how!
An amazing story he tells was about the rock band Van Halen! Their insistence on no brown Mand M’s in the dressing room was a clever one! You must read that one to enjoy the power of checklist!
Now David Lee Roth’s notorious insistence that Van Halen’s contracts with concert promoters contain a clause specifying that a bowl of M&M’s has to be provided backstage, but with every single brown candy removed, upon pain of forfeiture of the show, with full compensation to the band!
And at least once, Van Halen followed through, peremptorily canceling a show in Colorado when Roth found some brown M&M’s in his dressing room. This turned out to be, however, not another example of the insane demands of power-mad celebrities but an ingenious ruse!
As Roth explained in his memoir, Crazy from the Heat, “Van Halen was the first band to take huge productions into tertiary, third-level markets.
We’d pull up with nine eighteen-wheeler trucks, full of gear, where the standard was three trucks, max. And there were many, many technical errors-whether it was the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through.
The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many human beings to make it function!
So just as a little test, buried somewhere in the middle of the rider, would be article 126, the no-brown-M&M’s clause!
So if the band member walks backstage and saw a brown M&M in that bowl then he would line-check the entire production!
There would be a high chance that there will be a technical error!
The mistakes for not following the whole protocol could be life-threatening!
In Colorado, the band found the local promoters had failed to read the weight requirements and the staging would have fallen through the arena floor!
The whole Idea was to make sure that the organisers have seriously gone through the list of technical specifications given to them and they have been taken seriously since a single misfire would have been catastrophic!
And like always, the non brown M&M’s saved the day!
The next place where checklists are a part and parcel of the team is the restaurant! You go to any food joint during the rush hour and you would be amazed at the speed and efficiency by which the work gets done! The orders get prepared like an assembly line and the food is delivered on time and with the same taste each time with very few misses! How the author’s friend mentioned that all her staff has to do is follow the recipe! Follow the checklist, suggest some modifications if you feel it is better then test the modifications and if better, incorporate them in the checklist and the cycle continues!
Atul was later contacted by the WHO for finding out the checklist for surgery. The amount of surgery has grown by a lot and there has to be a protocol or rather a checklist so that the whole system is effective and monitored.
Though the incisions have become smaller, the recovery has become faster, the complication has increased. The major part of the rest of the book was how the surgical checklist used by almost all the hospitals in and around the world was formed!
Then a landmark study which was found to happen in Karachi Pakistan, so they were increase rate of infection, diarrhoea, skin diseases, and of course death. So one of the investigators who tried to change the whole problem or system understood that the problem is huge. Just get water, clean water, drinking water or even proper water at every house or household was going to be a big issue Facing with such major problems, they came out with a very simple solution SAOP! ONE MUST BE REMEMBER THAT EVERYONE HAD SOAP, BUT WHEN THE RESEARCHERS GAVE SOAP, THEY ALSO INSTRUCTED WHEN AND HOW TO USE SOAP THAT WAS THE CHECKLIST!
We do before any surgery, a checklist is done, and until the nurse gives the checklist done, it is not ready for takeoff! That was a very effective motto! Of course initial reluctance was there but later on it has become a part of the standard protocol in most all operation theatre!
What is the Self Help book not talking about Warren buffet! Though Atul tells us about one very rich guy and his partner or partners who have inspired by Warren but they have deduced that Warren may not have have checklist since he has more mistakes! They however use a checklist and do not go with their gut! In fact when they have followed their checklist, it has always been a profitable investment!
The final chapter are five amazing examples of using the checklist including one close one! Those five examples are the best indicators of the fact that the check list works!
So!
Make a checklist!
Make sure they are specific and not vague!
The items in the checklists are not supposed to be technical, they are only to remind you of the completion of the activity in a proper way!
The items are supposed to be simple and direct!
You can make multiple ones for different actions and frequently revisit them for any modifications or changes.
Most important of all, remember that you are not a multitasker! You are a mere mortal and you make mistakes! So if you want to do a job properly especially one that has many steps then make sure you have a checklist and FOLLOW THEM!
The final verdict! Loved it!
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