Atul Gawande’s list of accomplishments is stunning. He is an endocrine and general surgeon at Brigham and Women’s Hospital in Boston, Associate Professsor at Harvard Medical School and Harvard School of Public Health, a MacArthur Fellow, a contributor to The New Yorker and author of three best- selling books. His first book, “Complications”, was a finalist for the National Book Award in 2002 and his newest work, “The Checklist Manifesto” made it to the New York Times best seller list.
“The Checklist Manifesto” is a book that looks at how the modern world has become so complex that even a small error can cause large scale damage and loss of life. Gawande explores how different professionals from pilots to surgeons and structural engineers manage complexity, solve problems and reduce error in their work by developing and using checklists. Gawande began this project when he was invited by the World Health Organization to lead a project to reduce surgical deaths and complications. Given the vast disparity of resources and training of medical professionals in the world, this was a daunting task. The approach that he and his team take is to develop a simple tool—the surgical checklist—which when regularly and successfully deployed during trials at eight major hospitals around the world (including the University of Washington Medical Center in Seattle) led to stunning reductions in complications and death.
The development of such a checklist, however, is not that easy. While Gawande was aware of some local use of medical checklists such as one in Austria which saved a young drowning victim to one used at Johns Hopkins ICU to reduce central line infections in critically ill patients, he explores how other professions develop checklists and deploy them to save lives. He meets with a structural engineer specializing in skyscrapers who shows him how checklists work in that industry and with Boeing engineers who develop checklists for pilots. From these kinds of examples, Gawande and his team build a surgical checklist that develops team work in an operating room, decentralizes power such that the chief surgeon is not an autocrat, and increases communications between team members.
Gawande’s book is evangelical in its intent—his goal is to tell the story of a simple solution to a complex problem and to celebrate its success in a variety of global health situations. He also wants to persuade surgeons, health care policy mavens, and hospital administrators to use the checklist to save many lives. His data is persuasive. In the WHO trial, they studied 4000 patients and expected to have 435 complications (based on their observations of pre-checklist conditions). The deployment of the checklist reduced that number to 277 and spared 150 people from complications and 27 from death.
An evangelical manifesto about checklists and surgery does not sound like the raw material for a best seller. What makes Gawande’s book fascinating to the ordinary reader is his conversational style, his ability to tell gripping stories about surgeries, aviation emergencies (including the 2009 miraculous landing of a US airways flight on the Hudson river), and building processes. His argument about using checklists is persuasive and might inspire other professions to develop their own. Perhaps, the average reader might also want his/her own checklist. A harried parent driving a car load of kids might, for example, want to take a few seconds to ensure that all the kids are safely buckled in their car seats before pulling out of her driveway. Or a constantly traveling professional might want to develop a small checklist to be used before each trip to reduce oversights in planning. This book will likely inspire people to use checklists to avoid errors in their increasingly complex personal and professional lives. More importantly, it will persuade many of us to check if our hospitals and surgical teams use checklists before we commit to any surgical procedure.
Atul Gawande will be reading from his book on May 3 at the Seattle Arts and Lectures, beginning at 7:30 p.m. 105 S. Main St., Suite 201, Seattle 98104.
