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The Checklist Manifesto: How to Get Things Right

Book by Atul Gawande · 15 quotes · Human Nature, Attention, Attention To Detail

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The Checklist Manifesto: How to Get Things Right Quotes

“What is needed, however, isn't just that people working together be nice to each other. It is discipline. 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.”

“Good checklists, on the other hand 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. Instead, they provide reminders of only the most critical and important steps--the ones that even the highly skilled professional using them could miss. Good checklists are, above all, practical.”

“We are all plagued by failures - by missed subtleties, overlooked knowledge, and outright errors. For the most part, we have imagined that little can be done beyond working harder and harder to catch the problems clean up after them. We are not in the habit of thinking the way the army pilots did as they looked upon their shiny new Model 299 bomber — a machine so complex no one was sure human beings could try it.”

“All involve risk, uncertainty, and complexity — and therefore steps that are worth committing to a checklist and testing in routine care. Good checklists could become as important as doctors and nurses as good stethoscopes (which, unlike checklist, have never been proved to make a difference in patient care). The hard question — still unanswered — is whether medical culture can seize the opportunity.”

“Having great components is not enough. We are obsessed in medicine with having great components, the best drugs, the best devices, the best specialists, but pay little attention to how to make them fit together well. Berwick notes how wrong-headed this approach is. Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence, he says. He gives the example of a famous thought experiment, of trying to build the world’s greatest car by assembling the world’s greatest car parts. We connect the engine of a Ferrari, the breaks of a Porsche, the suspension of BMW, the body of a Volvo. What we get, of course, is nothing close to a great car. We get a pile of very expensive junk.”

“You would think that this would be whether the entrepreneur’s idea is actually a good one. But finding a good idea is apparently not all that hard. Finding an entrepreneur who can execute a good idea is a different matter entirely. One needs a person who can take an idea from proposal to reality, work the long hours, build a team, handle the pressures and setbacks, manage technical and people problems alike, and stick with the effort for years on end without getting distracted or going insane. Such people are rare and extremely hard to spot.”

“For all the differences among the eight hospitals, I was nonetheless surprised by how readily one can feel at home in an operating room, wherever it might be. Once a case was underway, it was still surgery. You still had a human being on the table with his hopes and his fears, and his body opened up to you, trusting you to do right by him. And you still had a group of people striving to work together with enough skill and commitment to warrant that trust.”