Book Discussion: Checklist Manifesto

Monday April 10, 2017

Humans are fallible. This idea is the theme of the past three books I've read. Pitch Anything focuses on the idea that people typically make decisions at an instinct level rather than analytically. The Undoing Project shows how humans are heuristic machines, and while the heuristics are right in many cases, they are systematically wrong in others. The Checklist Manifesto prescribes fixes for the limited capacity of our memory and problem-solving ability.

I'm already familiar with the effectiveness of checklists. In Operations, checklists are used in many ways in a tool called Runbooks. We used them at One Salon, and Uber made heavy use for everything from operations, incident response, and city launch.


The book emphasizes several key traits of effective checklists. A checklist for making checklists, if you will.

  1. Checklists should be fairly short (ideally 5-7 items)

  2. Checklists should be refined through actual usage.

  3. Checklists shouldn't (necessarily) include the obvious steps that are never missed.

From Gawande's pre-surgery checklist, he shares one of the steps: make sure each person in the operating room knows the name and role of each other person. He found that this simple change made people take more responsibility and ownership and made them more likely to speak up when they see something off, ownership for when situations go wrong.

In pilot studies, the introduction of this checklist reduced surgery complications by one-third and death rates by almost one-half: astounding results.


Humans have made amazing progress over the course of civilization. As a civilization, we have developed cures for disease, come to understand incredible complexity about the natural world, and completed truly awesome feats of engineering.

Books like the Checklist Manifesto drive home the progress we've made because of advances in slightly softer disciplines. As mentioned, Gawande's surgical checklist (along with many other examples in the book) brought about improvements comparable to sanitation or other revolutionary medical innovations.

Part of the impedence to the universal acceptance & implementation of operational ideas like the Checklist is the difficulty to replicate results. Take Gawande's surgical checklist: it turns out many hospitals weren't able to replicate the astounding results of their pilot study. See this Nature article for more details. The short of it is many people didn't use the checklists correctly and did not follow the steps.

I'm convinced there are many critical, proven, life skills that aren't taught in schools or formal education: skills like using checklists, mood control habits, habit formation skills, crucial communication skills, and more. For friends reading this, I'm curious what scientifically proven skills you think should be taught broadly yet are not.

On that note, upcoming on my book list is Tools of Titans, and I'm eager to see this topic be addressed there.

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