Tick your way to efficiency
Reviewed by Jayanti Roy

The Checklist Manifesto: How to Get Things Right
By Atul Gawande.
Penguin Books. Pages 209. Rs 399.

The world is becoming more and more complex. With an avalanche of new technologies and an enormous amount of knowledge and information input, even our daily lives are becoming confusing labyrinths of details, deadlines, doís and doníts. Most of us will agree that we all seem to drown in a deluge of this complexity. Now, add to this increasing complexity a crisis situation where human lives are at stake. For example, operation theatres where a single mistake can be the only difference between life and death or a flight in midair where a pilotís forgetfulness may cost hundreds of lives. It is assumed that surgeons, doctors, pilots and people who work in such stressful conditions can overcome intense pressures and cut through the tentacles of complexities through their rigorous training and experience. The author shows that it is not always so. They too need support and constant checking and rechecking to guarantee that every step needed is taken in the right direction.

Complexities are overwhelming. In any sphere of life, whether it is medicine, engineering, aviation or architecture, new tools, techniques, specialisations and innovations have arrived making simple and easier tasks highly daunting. To ensure that a critically ill patient arriving in an Intensive Care Unit receives appropriate treatment after passing through a long chain of myriad acts performed by a large number of professionals without a single glitch will be to expect too much. Human errors, inadequate knowledge, faults in implementation all could be equally valid reasons for mistakes to creep in and wreak havoc.

Can more intensive training or enhanced expertise or extensive experience be the key to the challenge of complexity? The author through anecdotes, real-life events, relevant statistics and research findings gradually builds up an argument.

He points out that the most effective way to handle multi-factorial situations demanding increasing degrees of efficiency is the use of a simple checklist. He borrows examples from architectural projects to build skyscrapers and aviation industry. He even takes inspiration and experiences first hand how chefs handle the restaurant kitchen to dish out the recipes of culinary excellence with just the right combination of flavour and taste in such mind-boggling varieties, serving each client specifically according to his or her needs.

This interdisciplinarity is one of the best features of the book, which is basically about how medicine and specially surgery can benefit from using task and communication checks. But along the way, the author also shows us that this can be true for any and every profession and situation.

Atul Gawande, a surgeon working in Boston, has the knack of discussing serious aspects of medicine without appearing glum and arrogant. His earlier books, Complications and Better have won him much acclaim. He has got fascinating insights. The simplicity of his suggestions sometimes does seem unbelievable, but that is the crux of his argument, too. He is right when he says practice does not make us perfect but complacent. We have to be constantly on guard to do all the steps right not only when we are novice but more so when we are experts and we are smug in our knowledge. His emphasis on the basics and on values like discipline might seem to be old fashioned, but it is a lesson well learnt. For, though the author does not say so, preparing a checklist for an assignment is not an easy task. It is indeed the job of a master who knows it inside and out.

The book is of value to the professionals, public health experts, management groups, students, teachers and in short, to anyone in general who is interested in knowing how to get things right. The notes on sources are detailed and can be a useful resource. With such a well-rounded presentation, one can only wish that the author had included the checklist scenario in the chaotic fields like film-making, defence and military and scientific expeditions!