
Highlights from “The Checklist Manifesto” by Atul Gawande - chegra
https://www.chestergrant.com/highlights-from-the-checklist-manifesto-by-atul-gawande
======
wjnc
It's a fine book. My learning after that book was to try to ask for and read
the checklist for medical procedures my family members undergo. At least over
here (the Netherlands) they are usually given without problem or even
publically accessible online. In case of the chemo of my father, I was able to
point to missed steps twice, once needing immediate intervention. In case of
simple family disease I can at least understand the reasoning of our GP
without totally cross-examining him.

In work I've only once (alas) hit the sweet spot of having team members being
able and willing to define their own checklist and following and refining it
regularly. The results were pretty great (30x efficiency gains on the same
procedure in two years). Since, I've noticed quite a lot of professionals
being resistant to the idea of checklists. The dogma is that you can't capture
skill, experience and intelligence in a checklist. That's a false dichotomy,
since the checklist is ment to save you from embarrassing errors, but it's a
persistent thought.

~~~
zentiggr
After being in the Weapons Department of a submarine crew, I generally swear
by checklists, or a tthe very least, not just a 'let's think about this'
session but as close to a walkthrough as I can manage. Vacation planning?
Major holiday shopping/preps? New pet? (Other unusual circumstance?)

Imagine what it will be like to live through the time and actions that you
expect, and almost guaranteed, the gotchas will pop out like a sore thumb, and
you'll be planning ahead for those.

Wherever I can get to a checklist level, though, I do. Even if it's a list of
possible options that I only select a few priorities from each day, it keeps
me in mind of the possibilities and things I may be neglecting, etc.

~~~
halfbrown
Always nice seeing a fellow submariner here at HN. :) I feel the same way,
though I was in Radio on a fast attack out of Pearl: Checklists are the way to
go. Now as a civilian, I'm always extolling the benefits of (regularly
updated) checklists to my co-workers.

------
erentz
I was working at [a large cloud company] a couple of years after this book
came out when suddenly all the managers (in my area) started reading it in a
very short space of time. They became completely prepossessed by checklists,
but IMO totally misunderstood what makes an effective checklist. They turned
checklists into an oppressive regime of documenting every conceivable step and
path to the tiniest detail. Checklists became impossibly long and far to
cumbersome to be useful.

These managers wanted to treat engineers as robots and thought these
checklists would be the code they fed into other flesh-robots, that then
wouldn't need to know anything about what they were doing. Meanwhile the real
engineers among us wanted to write actual code that would run on actual
computers to do automation and scale instead. But the managers couldn't read
code so didn't trust this desire of these engineers and stifled it for a
considerably long time. It was a frustrating interpretation of a book I
otherwise enjoyed.

~~~
js2
> They turned checklists into an oppressive regime of documenting every
> conceivable step and path to the tiniest detail.

That‘s a shame since this exact pitfall is covered in the book when the first
list he comes up with for an operating room fails spectacularly because it’s
over-detailed. He has to circle back and revisit the checklists used by pilots
and realized they only cover the most essential steps. He also discusses the
difference between a pilot’s checklist and the checklists used in construction
projects and why they have different levels of detail.

------
crispyambulance
I can see how checklists are valuable for extreme high-stakes but routine
operations, like surgery or aviation.

But in practice, in the realities that we face in non-life-critical jobs,
they're oppressive.

Some project managers cling to the fantasy that work will get done in a
predictable and orderly fashion if only they wrote down everything that needs
to be done and put checkbox next to it (preferably with a target date). The
problem is for many projects we don't know what needs to be done in advance or
we don't have a deep bench of experienced talent that is able to even generate
a realistic checklist.

What often happens with these "checklist project managers" is that they end up
creating excessively turgid checklists for which many items are inapplicable
to the task at hand, many important items are utterly missing, and there's no
prioritization of which things are truly the most critical-- everything's just
an identically emphasized line item.

Checklists are for activities which are _extremely_ well understood, practiced
exhaustively, and also critical to the mission.

~~~
ellius
You can get value from making your own. I have a small list for coding that
says "commit, test, story" that reminds me to be always saving my work, coding
against a test, and testing against a story. As long as you remember that
you're the one in charge and don't treat it like your boss, a list can be a
great aid to memory and discipline.

~~~
crispyambulance
You're right there's a lot of value in writing down what you need to do on a
personal level, adapt and modify it to suit yourself and the situation at
hand. It's not "your boss" and that's why it helps.

I am talking about checklists devised in a work situation by "a boss" as an
integral part of how work is actually preformed.

It's sooo easy for these things to get stupid when they're abused. A
checklist, used improperly, is like a pre-waterfall workflow-- almost
militaristic in it's simplicity.

------
Tomte
Read the fantastic essay by the author in the New Yorker:
[http://www.newyorker.com/magazine/2007/12/10/the-
checklist](http://www.newyorker.com/magazine/2007/12/10/the-checklist)

He expanded the essay into the book. The book is only okay, because it adds
length and a few anecdotes, not all of them convincing, but the best stuff is
also in the article.

~~~
asplake
Also his 2014 Reith lectures (a BBC institution):
[https://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82h...](https://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-
atul-gawande-2014-reith-lectures)

------
digb
It was a fine book, but this summary serves the point perfectly while also
being way shorter. My working assumption with all these popular books is they
could be half (or less) as long and retain effectiveness.

~~~
ghaff
There are a _lot_ of books that really deserve more than a magazine article or
summary. You get context, examples, maybe some history, and so forth.

But they could probably be, say, 75 pages rather than 250. The problem is that
the economics and practices of the publishing industry--and, in all fairness,
the expectations of most book buyers--are built around 250-300 page books. So
authors end up padding out their 75 page book to 250+ pages.

Philip Greenspun wrote the following in _2003_. It was in the context of blogs
as an alternative but the reality is that books still carry a certain gravitas
that online publishing usually doesn't have.

"Let’s go back to the beginning. The commercial publishing world supports
basically two lengths of manuscript: the five-page magazine article, serving
as filler among the ads; the 200+-page book. If you had a 20-page idea and
didn’t have access to the handful of “long-copy” magazines in the U.S. (old
New Yorker, Atlantic, etc.), you could cut it down to a meaningless 5-page
magazine piece or add 180 pages of filler until it reached the minimize size
to fit into the book distribution system (cf. any diet book or business
bestseller)."

~~~
esoterica
There are also essay collections. You can write 10 20 page essays and turn
that into a book.

~~~
ghaff
In my experience, it works better for relatively timeless self-contained
topics. (Or for topics that are interesting in a historical context for
whatever reason.)

I find it works less well when you're just hoovering up a bunch of random
content that was perhaps interesting relative to current events and trends but
is less so in isolation. Nothing wrong with doing it as a way of archiving
past work but it's probably not something that's likely be to the average
reader.

------
pp19dd
An important takeaway from the book I got was that distilled checklists didn't
work alone. It took some flexibility within the environment using the
checklist to allow for its full potency, such as nurses being allowed to
second-guess a doctor without fear of reprisals.

In the tech industry I think we can apply the construction company example
more appropriately, which was construction companies structuring themselves
over the decades for an immediate rescheduling of work and inspections to meet
a construction sequence when something came up.

To be blunt and cynical, I don't believe that today's software management
styles and scheduling are realistic in that manner. Whatever calendar
flexibility exists is covered in name only. So I feel that too often project
management decisions serve the calendar instead of allowing field hands to
push back on launch dates.

~~~
r00fus
Having a checklist is just the start. Adoption of checklists and training on
them is almost as critical and sometimes far more difficult.

Sometimes leading by example (coworkers seeing positive outcomes) is the best
way to gain adoption within your org.

Like all artifacts - things can get stale - maintenance of the checklist needs
to be part of the overall group's ongoing tasks.

------
rramadass
The New Yorker article on which the book was based was a real eye opener for
me. That something so simple and so well known could have such dramatic
effects in real life was unexpected. It was the magnitude of the effect that
was a revelation.

Generalizing, since then i have consciously tried to force myself to
follow/look at the simplest possible technique/explanation/etc. in all my
endeavours. Our modern life is so much filled with _incidental complexity_
that 90% of the time a simple approach always works. It has all been done
before and we just have to follow established conventions/heuristics.

------
ThrowMeAwayOkay
I'm building a SaaS around creating repeatable checklists (and procedures).
Experienced people know how to do their jobs, but they are still people.
People are error prone even on a good day. On bad days, well...

~~~
ecornflak
Please include a function to print nice looking versions. My not-for-profit is
still quite paper based and when the checklist is online and the paper it
relates to is offline the checklist doesn't get used.

------
dang
Related from yesterday:
[https://news.ycombinator.com/item?id=21283398](https://news.ycombinator.com/item?id=21283398)

