The Checklist Manifesto - Atul Gawande

The Checklist Manifesto - Atul Gawande

 Video Book Summary

Book Summary Notes

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The Checklist Manifesto

“Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things." 

"Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields—from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us."

"That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy— though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies."

"It is a checklist.”

Ignorance & Ineptitude

“In the 1970s, the philosophers Samuel Gorovitz and Alasdair MacIntyre published a short essay on the nature of human fallibility that I read during my surgical training and haven’t stopped pondering since. The question they sought to answer was why we fail at what we set out to do in the world. One reason, they observed, is ‘necessary fallibility’—some things we want to do are simply beyond our capacity. We are not omniscient or all powerful. Even enhanced by technology, our physical and mental powers are limited. Much of the world and universe is—and will remain—outside of our understanding and control."

"There are substantial realms, however, in which control is within our reach. We can build skyscrapers, predict snowstorms, save people from heart attacks and stab wounds. In such realms, Gorovitz and MacIntyre point out, we have just two reasons that we nonetheless fail."

"The first is ignorance—we may err because science has given us only a partial understanding of the world and how it works. There are skyscrapers we do not yet know how to build, snowstorms we cannot predict, heart attacks we still haven’t learned how to stop. The second type of failure the philosophers call ineptitude—because in these instances the knowledge exists, yet we fail to apply it correctly. This is the skyscraper that is built wrong and collapses, the snowstorm whose signs the meteorologist just plain missed, the stab wound from a weapon the doctors forgot to ask about.”


Sometimes the knowledge just simply isn't their to succeed in what we are trying to accomplish..

This is very common in fields where you are pushing the boundaries of 'what we know' but much less common in most other fields now..  Especially due to the internet!

This is rarely the case when it comes to self development/self improvement because there is just so much good information out there!  It's much harder to figure out how to apply the information that it is to actually find useful information.

Can you think of a time that you failed at something simply because you didn't know what you were doing? 

  • Was it ignorance because you didn't seek out the information you needed or because the information wasn't there and failure is a necessary part of learning?


Sometimes the knowledge is out there and perhaps even within us..  But we don't simply because of ineptitude!

This is where you are moving from theory to practice and the gap between those two things is often larger than you think.

How many things do you 'know' how to do but don't do on a regular basis?  

  • One of the best ways to move from theory to practice?  
  • Create a Checklist!

The Unflyable Plane

“What they decided not to do was almost as interesting as what they actually did. They did not require Model 299 pilots to undergo longer training. It was hard to imagine having more experience and expertise than Major Hill, who had been the air corps’ chief of flight testing. Instead, they came up with an ingeniously simple approach, they created a pilot’s checklist."

"The test pilots made their list simple, brief, and to the point—short enough to fit on an index card, with step-by-step checks for takeoff, landing and taxiing. It had the kind of stuff that all pilots know how to do. They check that their brakes are released, that the instruments are set, that the door and windows are closed, that the elevator controls are unlocked—dumb stuff. You wouldn’t think it would make that much difference. But with the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident. The army ultimately ordered almost thirteen thousand of the aircraft, which it dubbed the B-17. And, because flying the behemoth was now possible, the army gained a decisive advantage in the Second World War, enabling its devastating bombing campaign across Nazi Germany.”

This is from the chapter where we are introduced to The Checklist and is one of the great stories in the book!

  • This story is about the Boeing Corp. in 1935 who is showcasing their new plane to the army..  Which is basically 'bigger and badder' than their current versions!
  • Maybe too big and bad..  As the first pilot who flew the plan crashed it 300 feet after takeoff!
  • The army deemed the plan 'too much for one man to fly'
  • Well you know the rest of the story.. They created a checklist!

Pause Points

Atul talks a lot about inserting checklists at 'pause points' in whatever process you are partaking in..


  • Flying: Taking off and landing
  • Surgery: Before anesthetics and before incisions

Where Are Your Pause Points?

Let's talk about your day..  I imagine if your day is anything like mine it can often feel 'too big for one man to fly'!

But where are your days pause points?

  • For me it's the beginning of my day and the end of my day..
  • At the beginning of my day I have a mental checklist I check off; wake up, meditate 20 min, caffinate, move 5 mins and deep work for 90 minutes
  • At the end of my day I have a mental checklist again; phone off, read a book, CBD and magnesium and head to bed when tired.
  • These both help me control my days and make them feel less like they are 'too much for one man to fly'

Reduce Mortality by 47%

“‘You’ve got to see this,’ Alex said.

"He laid a sheaf of statistical printouts in front of me and walked me through the tables. The final results showed that the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after introduction of the checklist. Deaths fell by 47 percent."

"The results had far outstripped what we’d dared to hope for, and all were statistically highly significant. Infections fell by almost half. The number of patients having to return to the operating room after their original operations because of bleeding or other technical problems fell by one-fourth. Overall, in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observational data. But instead just 277 did. Using the checklist had spared more than 150 people from harm—and 27 of them from death.”

Checklist Superheros

This is just one of the astonishing examples of how powerful checklists can be even in highly knowledge-based professions

  • Finance
  • Medical 
  • Aviatation

Check the Fundamentals

  • Any complex tasks requires that we regularly check the fundamentals
  • Having a strong base of fundamentals allows us to maximally focus on the nuances that we should be focusing on
  • *Even though data like this is out there most people still aren't using checklists!  This can be your competitive advantage

Create Your Checklist

“The fear people have about the idea of adherence to protocol is rigidity. They imagine mindless automatons, heads down in a checklist, incapable of looking out their windshield and coping with the real world in front of them. But what you find, when a checklist is well made, is exactly the opposite. The checklist gets the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with ... and lets it rise above to focus on the hard stuff.”

Free Yourself

"Be regular and orderly in your life so that you may be violent and original in your work.: - Gustav Flaubert

When we systemize/routinize/checklist the basic things we do on a daily basis we free ourselves to do the work that really matters

Your Checklist

Good checklists are short precise and practical

  • Creating a checklist that is short but still useful is actually harder than creating a monster list..  Because it requires you to boil down the 80/20 of what actions truly matter!
  • Checklists are like a living breathing document where as you learn you change the list

Best Day Checklist Example

  • What THREE things do you do when you have your best day?
  • 1.
  • 2.
  • 3.

Create this list/repeat it/update.

Code of Conduct

“All learned occupations have a definition of professionalism, a code of conduct. It is where they spell out their ideals and duties. The codes are sometimes stated, sometimes just understood. But they all have at least three common elements."

"First is an expectation of selflessness: that we who accept responsibility for others—whether we are doctors, lawyers, teachers, public authorities, soldiers, or pilots—will place the needs and concerns of those who depend on us above our own."

"Second is the expectation of skill:that we will aim for excellence in our knowledge and expertise."

"Third is an expectation of trustworthiness: that we will be responsible in our personal behavior toward our charges."

"Aviators, however, add a fourth expectation, discipline: discipline in following prudent procedure and in functioning with others. This is a concept almost entirely outside the lexicon of most professions, including my own... 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.”

Human Code of Conduct

This is from the chapter "The Hero in the Age of the Checlists"

Perfect checklist for our code of conduct as humans

  • 1. Selflessness
  • 2. Excellence
  • 3. Trustworthiness
  • 4. Discipline

How can you embrace this simple checklist in your life and work?

  • What points would you add to this checklist?
  • Test/Repeat/Update
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