Book World: Review of The Checklist Manifesto, by Atul Gawande

Sunday, January 17, 2010; B07


How to Get Things Right

By Atul Gawande

Metropolitan. 209 pp. $24


Sometimes a deeply complex problem has a deceptively simple answer. That is the underlying message of Atul Gawande's "The Checklist Manifesto," which explains how a short, straightforward medical checklist can greatly reduce the chances of failure in life-or-death situations (and some less serious ones, for that matter).

Himself a surgeon, Gawande argues that the medical field has, in some ways, become too sophisticated for its own good. "The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably," he writes. "Knowledge has both saved us and burdened us."

To see how clinicians might do better, Gawande turned to experts in other fields. He studied aviators, chatted with high-stakes investors and visited with an architect working on a skyscraper. A common thread emerged: All of them used some sort of checklist. Curious whether this approach could work in medicine, Gawande hunted for situations where checklists were used in his own field.

Even skeptical readers will find the evidence staggering. Gawande found a host of studies that show dramatic drops in death or infection from a certain procedure once a hospital implemented a checklist for doing it right. Marshaling anecdotes and analysis, he implores the medical community to use checklists more widely. He also makes the case for rethinking teamwork and leadership in hospitals. While many surgeons are autonomous rulers of the operating room, he argues that decentralizing power among nurses, anesthesiologists and other physicians increases communication and reduces error.

Thoughtfully written and soundly defended, this book calls for medical professionals to improve patient care by adopting a basic, common-sense approach.

-- Sarah Halzack


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