A book about improving medical outcomes by using the humble checklist has lessons for engineers
I recently read The Checklist Manifesto: How to Get Things Right by Atul Gawande, published
by Metropolitan Books.
Atul Gawande is a surgeon who was part of a group sponsored by the World
Health Organization to improve surgery by developing and promoting a
checklist to improve surgical outcomes. The project
was successful in reducing complications and increasing survival rates
in every hospital in which it has been used. This book is about developing the
checklist and the research that went into it.
divides errors into two distinct types of errors: ignorance (thing we
don't know) and ineptitude (things we do know, but
don't think about). Many of the reasons for failure are due to the
second type of error. The humble checklist is the tool to keep us from
committing errors of ineptitude. The only way to eliminate errors of
ignorance is to recognize that we don't know everything
and, in fact, we do not know much of anything.
As engineers, we deal
with complex problems of design to meet requirements of specifications
and agency requirements. Almost all of the time we can create designs
that meet the requirements, but sometimes we fail. Most failures, in my experience, fall within the area of
interfacing with other engineers and programmers or are memory-related.. A checklist, used properly, can help to avoid these kinds of failures.
This relatively thin
book covers the various types and uses of checklists by giving examples in the areas of civil engineering, aviation, restaurants, and,
of course, surgery. In addition it provides a detailed
look at the development of a checklist for use in surgery, with examples on how a checklist
is designed, tested, and adapted for use.
The section on the
aviation checklists provides useful information on how to design real-world
checklists. If you need more information in this
area, the bibliography provides references that cover this
topic in more detail.
One example used in
civil engineering is a checklist that consists solely of the names of people who need to be informed of
problems and need to sign off on solutions. This is an excellent and non-obvious use of a checklist: to promote communication
between interested parties and ensure that information is shared.
The book is a riveting read and hard to put down, and it gave me some great insights into my own processes. Currently when I start a
design, I have a list of specifications that the design has to meet,
both regulatory requirements and customer-supplied specifications. Most
of these are hammered out in meetings with the
customer's representatives. Some of these requirements are generated by
me from a general statement of what the customer wants or a detailed
requirement submitted by the customer. The final statement of work acts
as, well, a checklist.
Radcliffe Cutshaw is a creative private consultant in the areas of RF design and RF development and wireless. He is also involved with writing.