This book is for anyone who believes in the importance of checklists for the smooth running of organisations. The author, a surgeon himself, opens by discussing the banter that goes on between surgeons on their ‘great saves’ and ‘great failures’. He ponders on why we fail in the medical world; we simply lack full understanding or either fail to apply our knowledge. Knowledge and technical sophistication have increased but what of our ability to deliver? This is where the ‘checklist’ comes in. According to Gawande, ‘expertise is the mantra of modern medicine’ in this ‘era of the super specialist’, but despite the expertise, mistakes can still occur. Checklists first appeared in the field of aeronautics in the form of pilot’s checklists. And so the author’s journey of discovery begins.
After visiting people in the skyscraper industry and the restaurant and investment worlds we find Gawande working with the World Health Organization’s global programme to ‘reduce avoidable death and harm from surgery’. Alarmingly, he points out that worldwide 7 million people are left disabled and 1 million dead from surgical complications. He highlights that surgery has four big killers: infection, bleeding, unsafe anaesthesia and the unexpected. The WHO safe surgery checklist was formulated, with nineteen checks in all. Now it was time to put it to the test. It would be assessed in eight hospitals worldwide. In the Spring of 2008, the 2-minute, 19-step checklist, was implemented in the hospitals. Out of the 4000 patients studied, the checklist spared 150 people from harm and 27 from death. The findings were published in the New England Journal of Medicine in 2009.
Gawande concludes that the checklist alone isn’t enough to improve safe practice but that teamwork and discipline are also crucial. Checklists also have a role beyond the operating room. Gawande’s brilliance as a doctor and academic is without question, but what is really admirable is his humility, in that he has an ability to share his experiences honestly and openly with those around him, his patients, and his readers. His down-to-earth style is obvious from the way he reaches out to experts in other fields to learn the ‘tricks of their trade’ and applies them in the medical world.