A Life-Saving Checklist (2007)(newyorker.com)
newyorker.com
A Life-Saving Checklist (2007)
https://www.newyorker.com/magazine/2007/12/10/the-checklist
35 comments
I'm a volunteer firefighter. One of the drawbacks of being a volunteer is that we don't typically get as much experience as our career counterparts, and that means in particular that we get less chance to develop muscle-memory and actual-memory of how to do things [0].
Consequently, I've come to have a much greater regard for simple checklists that make sure that we're doing basic stuff, we do it right. My favorite example: switching the fire engine's engine from driving the transmission to driving the pump. It's basically 3 or 4 steps, but when you only do this (at most) once a month (typically), remembering the steps is challenging, and it is even harder to remember to do the mandatory 2-3 second pause between each one.
The contrast with my life as a C++ developer for 35+ years is telling. In that world, almost everything is memory, and what isn't is both (a) look-up-able online (b) not time- or life-critical.
The brief time I've been a firefighter has made me very aware of a totally different side of my cognition - no, Paul, you actually don't remember most things at all - and has given me a great deal of respect for checklists to help prop up our minds in one of their weakest areas.
[0] truth is, I doubt that even the career firefighters in a lot of departments get enough daily experience for most things to become memorized, certainly not without many, many years responding to calls.
Consequently, I've come to have a much greater regard for simple checklists that make sure that we're doing basic stuff, we do it right. My favorite example: switching the fire engine's engine from driving the transmission to driving the pump. It's basically 3 or 4 steps, but when you only do this (at most) once a month (typically), remembering the steps is challenging, and it is even harder to remember to do the mandatory 2-3 second pause between each one.
The contrast with my life as a C++ developer for 35+ years is telling. In that world, almost everything is memory, and what isn't is both (a) look-up-able online (b) not time- or life-critical.
The brief time I've been a firefighter has made me very aware of a totally different side of my cognition - no, Paul, you actually don't remember most things at all - and has given me a great deal of respect for checklists to help prop up our minds in one of their weakest areas.
[0] truth is, I doubt that even the career firefighters in a lot of departments get enough daily experience for most things to become memorized, certainly not without many, many years responding to calls.
> The biggest takeaway for me was that checklists are not a piece of paper; they're a system.
I understood this when I read about plane pilots checklists. It's revolutionary even for everyday life. Every time we fail at something (for example leaving the vacation home with coffee still in the coffee machine), it goes to a checklist.
When something failed because it wasn't on a checklist, we say (wife and I) we lacked precision. And that thing now goes to the checklist.
Having to buy a new fridge because you arrive and something stayed in the fridge for x months ain't fun (not to mention you're left without any fridge for potentially two days [e.g. if you arrive on a late saturday evening]). It's on a checklist now.
Ever had to do a U-turn and lose one hour because wife forgot the phone at home? Checklist.
Weirdly enough checklists allows you to be more sloppy, not less. It's literally taking stuff out of your minds.
Ticket you receive at a toll? Checklist: "I gave you the ticket, do you confirm you received the ticket?" / "I confirm you gave me the ticket".
It's fun too. We all learned, including my kid, the NATO alphabet. It is precise.
We've got digital backups of our recurring checklists.
Saved our arses sooooo many times.
I understood this when I read about plane pilots checklists. It's revolutionary even for everyday life. Every time we fail at something (for example leaving the vacation home with coffee still in the coffee machine), it goes to a checklist.
When something failed because it wasn't on a checklist, we say (wife and I) we lacked precision. And that thing now goes to the checklist.
Having to buy a new fridge because you arrive and something stayed in the fridge for x months ain't fun (not to mention you're left without any fridge for potentially two days [e.g. if you arrive on a late saturday evening]). It's on a checklist now.
Ever had to do a U-turn and lose one hour because wife forgot the phone at home? Checklist.
Weirdly enough checklists allows you to be more sloppy, not less. It's literally taking stuff out of your minds.
Ticket you receive at a toll? Checklist: "I gave you the ticket, do you confirm you received the ticket?" / "I confirm you gave me the ticket".
It's fun too. We all learned, including my kid, the NATO alphabet. It is precise.
We've got digital backups of our recurring checklists.
Saved our arses sooooo many times.
SpaceX and NASA countdowns aren’t quite checklists in the same sense of the surgeon’s or pilot’s checklist.
Those countdowns are verifying that a bunch of launch blocking gates have not been closed. The key difference is that it’s not a reminder for people of stuff that needs to be done. It’s more like a roll call to make sure they have a unanimous vote to go from all teams that have a stake.
Those countdowns are verifying that a bunch of launch blocking gates have not been closed. The key difference is that it’s not a reminder for people of stuff that needs to be done. It’s more like a roll call to make sure they have a unanimous vote to go from all teams that have a stake.
I ride a motorcycle on multi-day camping trips using custom-made luggage. I like watching those jump master viddies on the gram or utube
https://www.instagram.com/reel/DDc88wIxZsk/
https://youtu.be/WWO52n2UxqU
https://www.instagram.com/reel/DDc88wIxZsk/
https://youtu.be/WWO52n2UxqU
I did not know about this book. Thanks.
I’m a huge fan of checklists and annotating/updating them with more information (when, what, observations, etc.). I see a lot of value with checklists in managing the complexity and in making sure that something doesn’t just slip by. Even if I know several steps from memory, I’d still want a documented list to reduce/remove human error. After all, we may not have our best skills with us at all times and in all situations.
Unfortunately, the people I work with aren’t that interested in creating checklists or keeping the ones I create updated. But I trudge along hoping that sometime in the future they may get some value from it.
Unfortunately, the people I work with aren’t that interested in creating checklists or keeping the ones I create updated. But I trudge along hoping that sometime in the future they may get some value from it.
I have pretty bad ADHD. It comes and goes over cycles with a frequency measured in weeks/months.
When I'm doing poorly, I have a hard time functioning as an adult. So, I use checklists and phone reminders a lot, even for simple things. I use them to start the day with things like:
-make coffee.
-check calendar for schedule
- block out time / add reminders as needed for the day
-plan morning (I have a list of mandatory and optional morning activities, along with the time it takes to do them)
- pack lunch.
- take meds.
-pack for work: (laptop, id badge, work phone, headphones, sunglasses, phone charger/cables)
- make breakfast for kids (along with a recurring reminder to start this by 06:45)
-wake up kids (reminders at 07:00)
Etc, etc. You get the idea.
I can't make my brain remember to do basic activities, and I naturally vary my routine, and at the same time I really struggle to remember to do things unusual to my routine. But I can use my engineering side to work the problem. When my brain is performing poorly, these checklists are essential.
When I'm doing poorly, I have a hard time functioning as an adult. So, I use checklists and phone reminders a lot, even for simple things. I use them to start the day with things like:
-make coffee.
-check calendar for schedule
- block out time / add reminders as needed for the day
-plan morning (I have a list of mandatory and optional morning activities, along with the time it takes to do them)
- pack lunch.
- take meds.
-pack for work: (laptop, id badge, work phone, headphones, sunglasses, phone charger/cables)
- make breakfast for kids (along with a recurring reminder to start this by 06:45)
-wake up kids (reminders at 07:00)
Etc, etc. You get the idea.
I can't make my brain remember to do basic activities, and I naturally vary my routine, and at the same time I really struggle to remember to do things unusual to my routine. But I can use my engineering side to work the problem. When my brain is performing poorly, these checklists are essential.
I’m exactly the same. When we have the phone on CarPlay my wife will smile at the reminders that pop up.
‘Brush teeth’
‘Drink water’
‘Take vitamin d’
‘Feed dogs’
And I’m basically helpless without the reminders at the bad times.
My severe adhd is cyclical too.
‘Brush teeth’
‘Drink water’
‘Take vitamin d’
‘Feed dogs’
And I’m basically helpless without the reminders at the bad times.
My severe adhd is cyclical too.
i need to do this. may i ask which app you are using and how you set the reminders so that you see them regularly?
Just the reminders app. Also, I use water llama app for hydration. One symptom of my adhd is I get neither hungry nor thirsty like normal people so hydration is key.
yes i have a 1.5 liter bottle and i have to empty it till end of work. its allways on my desk. its so hard to do stuff i am not directly interacting with atm.
I’m not the one you asked, but I rely heavily on the Apple’s Reminders app.
Checklists are great! Until TPTB decide everything should be a checklist, and then that everyone needs to be trained to the checklist and no more than that, and then start punishing any deviation from said checklists, and the all the newbies go 'why should I learn all this technical stuff, it's not needed for the checklist?'.
And then something changes and no one knows how to do anything but follow the checklist that doesn't work anymore....
And then something changes and no one knows how to do anything but follow the checklist that doesn't work anymore....
A few jobs ago, one of the managers of my division read The Checklist Manifesto and decided everyone needed to read and did the Jerry Maguire move of buying everyone a copy to read.
It kind of worked the way you described. Everyone kind of stopped thinking and just became checklist apes.
It wasn’t until a few years later that I realized a major factor about checklists the book mentioned, but that management conveniently ignored: the checklist must only be one page. Any longer and people ignore it.
Critical step that our management ignored. They just saw it as a big, never ending, ever growing list of rules. Which isn’t the right way to think about it.
It kind of worked the way you described. Everyone kind of stopped thinking and just became checklist apes.
It wasn’t until a few years later that I realized a major factor about checklists the book mentioned, but that management conveniently ignored: the checklist must only be one page. Any longer and people ignore it.
Critical step that our management ignored. They just saw it as a big, never ending, ever growing list of rules. Which isn’t the right way to think about it.
https://www.checkmateaviation.com/ seems to agree, but they pack a lot into a 3-column checklist, where most items are just a few keywords.
I think this highlights the most important bit that is missing from most checklists... the why.
Yes we have a list of things to do, and we know that if we don't do all those things then bad things can happen, but the most important thing is to know why we are doing those things... Because when bad things start to happen despite following the list, you need to know why you are doing those things so that you have some hope of making it better.
Yes we have a list of things to do, and we know that if we don't do all those things then bad things can happen, but the most important thing is to know why we are doing those things... Because when bad things start to happen despite following the list, you need to know why you are doing those things so that you have some hope of making it better.
So, a check list for check lists is the most important check list?
Check :)
It's at the end of the book. Checklist for making checklists. Good stuff!
I have 3 kids and have been to visit A&E countless times over the years. I always note the hand written checklists stuck up in the walls of Triage and wonder how many of these were derived through trial and error and which were introduced by more experienced medics.
For some reason the fact that they've obviously been produced locally gives me more confidence that they've done the hard yards; professionally printed ones would instead make me think they're only up there because management wanted to raise awareness.
For some reason the fact that they've obviously been produced locally gives me more confidence that they've done the hard yards; professionally printed ones would instead make me think they're only up there because management wanted to raise awareness.
Archived. https://archive.is/0H188
Atul Gawande is the author of several books, the most familiar being "The Checklist Manifesto"
Atul Gawande is the author of several books, the most familiar being "The Checklist Manifesto"
Atul Gawande is a surgeon by training and an exceptional writer. He has authored several other wonderful books, known for his ability to explain complex topics in an accessible way. His website (http://atulgawande.com) features his books, articles, and papers along with information about his other endeavors.
I hope he'll return to writing.
I hope he'll return to writing.
I have this theory that a lot of best advice is very plain and boring, very repetitive, and so we need various stratagems to somehow overcome that, to present it to our minds in such a way that they can focus on it again. "Make checklists" may be the best example of this.
Honestly, his book, The Checklist Manifesto, could have been a long-ish article like this one. I still love the book as one of the best to get things done. And I re-read the book quite often.[1] I love checklists, either written down or in my mind for most events, either at work or in life.
One of my most abused pieces of advice to professionals and teams is to make checklists. This has even spilled into my family. I get my daughters, The Anxious Generation, to create checklists.
1. https://brajeshwar.com/2024/the-checklist-manifesto/
One of my most abused pieces of advice to professionals and teams is to make checklists. This has even spilled into my family. I get my daughters, The Anxious Generation, to create checklists.
1. https://brajeshwar.com/2024/the-checklist-manifesto/
What do you mean? This is exactly that article. It‘s substantially the same as the book. Why should he write a second mostly identical article?
> Why should he write a second mostly identical article?
That's not being suggested. What is being suggested is that the book could have been condensed into a mere article to begin with.
That's not being suggested. What is being suggested is that the book could have been condensed into a mere article to begin with.
That is the article! The same author, the same subject. What else do you want?
The article became a book. The comment is suggesting that the expansion was not an improvement.
They want the book not to exist.
I wonder how widely this has been implemented in hospitals around the world since this article was written in 2007?
This reminds me to re-read The Checklist Manifesto by Atul Gawande.
Why do that, when you could read the New Yorker article, A Life-Saving Checklist, by Atul Gawande?
No, you need to create a checklist.
I was mortified by how little attention most professors and students paid to this problem. Something like half the data collections I was helping on (as a lowly first-year PhD) had some problem with the data collection.
I read The Checklist Manifesto and used it to design my own checklist -- and crucially, checklist procedure -- for my data collections and it made a huge difference. Not only did I collect much better data, but I was able to do much more sophisticated multi-step experiments without making mistakes.
The biggest takeaway for me was that checklists are not a piece of paper; they're a system. It's not enough for the surgeon to have a checklist, they'll just glance at it and think "oh of course I did these things". They only work when the nurse reads the checklist, item by item, aloud to the surgeon (I later realized this is exactly what SpaceX and NASA are doing during launch countdowns). Additionally, the checklist itself needs to be iterated on many times, removing unhelpful items and adding things you miss. And the checklist MUST be one page, no more.
If I ran an experimental lab of any kind, the book would be mandatory reading.