Atul Gawande\'s Checklist manifesto is like Malcolm Gladwell\'s \'Tipping Point\' - in the sense that the idea was already there, until somebody came up and packaged it in a nice book.

Checklists for all kinds of activities have always been around, but Gawanade\'s book has gained prominence because Americans are getting fed up with rising healthcare costs and airline safety.

Main ideas from the book:

Why checklists are important
The checklist gets the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with, and lets it rise above to focus on the hard stuff.

All learned occupations have a definition of professionalism, a code of conduct. It is where they spell out their ideals and duties.

Discipline is hard - harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. 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.

1. We have two reasons that we may fail:
1. Ignorance
2. Ineptitude - knowledge exists, yet we fail to apply it correctly.

2. Three different kinds of problems in the world:
All can be broken into small steps.

1. Simple
For example, baking a cake from a mix. There is a recipe. Sometimes a few basic techniques to learn.

2. Complicated
For example, sending a rocket to the moon. They can sometimes be broken down into a series of simple problems. But there is no straightforward recipe. Success frequently requires multiple people, often multiple teams, and specialized expertise. Unanticipated difficulties are frequent. Timing and coordination become serious concerns.

3. Complex
For example, raising a child. Every child is unique. Although raising one child may provide experience, it does not guarantee success with the next child. Expertise is valuable but most certainly not sufficient. Outcomes for complex problems remain highly uncertain. It is possible to raise a child well. It’s complex, that’s all.

3. What usable checklists look like:

The checklist cannot be lengthy.

A rule of thumb some use is to keep it to between five and nine items,

After about sixty to ninety seconds at a given pause point, the checklist often becomes a distraction from other things. People start “shortcutting.” Steps get missed.

Keep the list short by focusing on the “the killer items” - the steps that are most dangerous to skip and sometimes overlooked nonetheless.

Ideally, it should fit on one page.

4. What bad checklists look like:
Bad checklists are vague and imprecise.

They are too long; they are hard to use; they are impractical.

They are made by desk jockeys with no awareness of the situations in which they are to be deployed.

They treat the people using the tools as dumb and try to spell out every single step.

They turn people’s brains off rather than turn them on.

5. What good checklists are like:
Good checklists are precise.

They are efficient, to the point, and easy to use even in the most difficult situations.

They do not try to spell out everything - a checklist cannot fly a plane.

They provide reminders of only the most critical and important steps - the ones that even the highly skilled professionals using them could miss.

Good checklists are, above all, practical.

6. DO-CONFIRM checklist vs. READ-DO checklist.
By themselves, however, checklists cannot make anyone follow them. You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist.

DO-CONFIRM checklist:
Team members perform their jobs from memory and experience, often separately. But then they stop.

They pause to run the checklist and confirm that everything that was supposed to be done was done.

READ-DO checklist:
People carry out the tasks as they check them off -for example, a recipe.

We adopt mainly a DO-CONFIRM rather than a READ-DO format, to give people greater flexibility in performing their tasks while nonetheless having them stop at key points to confirm that critical steps have not been overlooked.

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