Book Review – “The Checklist Manifesto: How to Get Things Right” by Atul Gawande

I had earlier read two engrossing books by Atul Gawande – Complications and Better. So when I saw The Checklist Manifesto while browsing in the neighborhood library, I decided to pick it up looking forward to an interesting read (some reviewers had strongly recommended it). The title also indicated that it may a good book to review for this weblog.

Well, I was partially right – it was suitable to post a review on this blog. So, here goes…

The main theme of the book is as follows:

• Over the years, many activities have become extremely complex.
• Even experts struggle to master and remember all the tasks they have to perform.
• Use of checklists can minimize human errors of oversight. In many cases this it can improve the performance significantly.
• Use of checklists can also help the experts focus on the difficult, tricky parts of a situation, rather than worry about the mundane activities.
• There is need to create better checklists, organize them for easy use and ensure that they are used.

The author uses examples from multiple industries and situations. The best ones are from hospitals and medical emergencies (Dr Gawande is a surgeon ). There are other examples from the airline industry (where pilots use checklists for normal as well as abnormal situations), construction industry, retail, and restaurants.

There is a whole chapter dedicated to research where the impact of the use of checklists in hospitals was studied. The research showed that there was a significant reduction in deaths (47% reduction) and major complications (36% reduction) for surgical patients. One interesting finding was that though only 80% of the hospital staff found the checklists useful, 93% of them said they would want a checklist to be used if they were themselves getting operated!

The book sometimes extends the concept of “checklist” beyond its normal usage. Here are a few examples of things that are treated under the concept of checklist in the book (though I believe they are different concepts, with their own place in “how to get things right”):

• Preparing detailed project plans, dependencies, action items, schedules and list of deliverables (example of a building construction project)
• Use of collaboration meetings (of experts) to handle non-routine situations (e.g., a building floor developing unforeseen problems)
• Empowerment for doing something extraordinary (how Wal-Mart employees went beyond their formal authority to help people affected by Hurricane Katrina)
• Use of focus, expertise and wits (how a pilot saved lives by crash landing on Hudson river in 2009 – by focusing on flying the plane, not on using a checklist!)

In trying to bring everything under the umbrella of “checklists”, the author dilutes the concept and utility of checklists as well as other equally important concepts of detailed planning, collaboration, empowerment, dedication, competence and focus. Maybe the title “The Process Manifesto” would have been more apt.

For people who are already convinced about the use of checklists, procedures, plans, collaboration meetings, etc., this book can provide you with interesting examples to relate to process skeptics in your organization. It can also provide process trainers with interesting case studies to relate to the class. You may also consider gifting this book to colleagues who resist the use of formal processes – the book is an easy read and is able to hold the reader’s attention reasonably well.

If you are looking for readymade checklists that will help you reach some level in CMMI®/ People CMM®, then this book is not for you .

Those who have read Gawande’s earlier books – Complications and Better may find The Checklist Manifesto a bit disappointing – it is not as engrossing as the earlier two. This is possibly because the earlier books focused primarily on hospitals, medicine and healthcare based scenarios, where Gawande has accumulated loads of experience. And in Checklist, he provides examples from other industries (aircraft manufacture, real estate, retail stores, restaurants, and so on) where he may not have had the same level of familiarity and insight.

Here are some details of the book, in case you want to get your hands on it:

Book Title: The Checklist Manifesto: How to Get Things Right

Author: Atul Gawande

ISBN-10: 1846683130

ISBN-13: 978-1846683138

Publishing Date: Jan 2010

Publisher: Profile Books

Available at: Amazon  and Flipkart

Other book reviews uploaded on the same blog:

• Book Review – “Workforce of One” by Susan Cantrell and David Smith

®-CMMI and CMM are registered in the U.S. Patent and Trademark Office by Carnegie Mellon University.

Hi,

If you like the posts on this blog and would like to be informed whenever a new entry is made, here is what you can do:

• Scroll back to the top of the page
• On the right hand side there is section called “FollowBlog via Email”
• In the space provided, type in your email id and click on the “Follow Blog” button (give your personal id, since companies often block wordpress)
• You will get a message for confirmation at that email id
• In the email there is a clickthrough link for confirmation – click on it and complete the formalities

Extreme Process Tailoring and Mapping – How much is reasonable? (Story of a Pizzeria)

Last Friday I decided to go to the neighborhood pizzeria for lunch. I was sure of what I wanted to eat, and knew it would cost me around 300 rupees (INR)¹. I took my usual place, and was greeted by a grinning waiter. After the standard “how are you, sir?” (someday I plan to actually narrate all my woes, but I was not in the mood to do so on that day ), he says, “We have the standard combo meal at a very special price, just 99 rupees.”

“And what can I get in the standard combo meal?” I ask.

“Well you can start with a soft drink, and…,” he says.

“I am not really interested in drinking colored sweet water that is gassed. Skip the combo, let us start with some tomato soup, regular size”.

The waiter would not give up on his combo order. “In the combo, I can substitute the soft drink with a soup, no problem.” Off he goes to get the soup.

After the soup arrives, he is ready to get the next dish. “Sir, shall I get the garlic bread?”

“Don’t you know that burnt flour has no nutritional value? Please get me a garden fresh salad instead – a regular portion,” I say.

He goes to check, comes back and says, “Sir, I can do only a small portion of salad instead of the garlic bread.” After some more discussions he agrees to serve a regular portion of the salad. He also says something about reducing the ice cream that comes at the end of the standard combo.

I manage to substitute the pizza with a pasta, and also wrangle a cup of tea instead of the reduced ice cream portion. I get the meal I wanted at 99 rupees (instead of the 300 rupees that I should have spent). Maybe the waiter also achieved something by selling one more “standard combo”.

If at the end of the day, the pizzeria tries to reconcile the billing data with what was produced in the kitchen, here is what they would have come up with, for my transaction.

(In reality the situation was much more complex, since I was with my wife. So the dishes we got should have been mapped to 2 standard combos. In the interest of the reader’s sanity, I have used “blogetic license” to simplify the situation ).

A process auditor/ reviewer would have been aghast – this was extreme tailoring (later justified by extreme mapping), violating all principles of reasonableness.

In typical organizations, there are often situations where one set of processes need to be mapped to another set of processes or some framework. Here are some of them:

• A new process standard (or is new version) is adopted and we need to identify the gaps in our processes with respect to the new standard
• Our customers would like to confirm that our processes satisfy some requirements of the customers’ standard
• Our process team wants to make sure that the customer imposed processes still continue to meet the requirements of our standard process, and
• Post an acquisition, we need to prove that our processes do meet our new owner’s standard processes

And it is in some of these contexts that we sometimes find unreasonable distortion- driven by the need to seem conforming while continuing to do something totally different. Over the years, expertise has been built in the industry and there seems to be a community of practice calling themselves X!reme Mappers² .

Excessive tailoring, if it is all-pervading in the organization, actually defeats the purpose of having a standardized process, and can prevent an organization from reaching maturity level 4/ 5 of the CMMI®/ People CMM®.

So maybe it is time someone defined limits of reasonable tailoring and mapping.

Any thoughts on how much tailoring is reasonable?

Other related posts uploaded on the same blog:

• Institutionalization in CMMI® and People CMM®: Converting a practice to a habit
• CMMI® – Constellations, Representations and some food for thought

®-CMMI and CMM are registered in the U.S. Patent and Trademark Office by Carnegie Mellon University.

1-      Rupee/ INR is the Indian currency. As per the current exchange rate (Feb 2012), 1 US$ is roughly = 50 Rupees. However, if we factor in the purchasing power in India, the rupee is much more powerful than what is indicated by the exchange rate. For example, in India you could buy 3 Kilograms of ripe bananas for 50 rupees – but one can’t live on bananas alone

2-      X!reme Mappers. According to the Processpedia (Volume 6 draft v23.4), X!reme Mappers is a shadowy guild, and is affiliated to the Society of Dark Process Arts. They can be hired only through word of mouth and have the motto “We can map anything to anything. You continue doing your thing, while we take care of the mapping.” More information on X!reme Mappers can be found in the draft version of Processpedia.

Hi,

If you like the posts on this blog and would like to be informed whenever a new entry is made, here is what you can do:

• Scroll back to the top of the page
• On the right hand side there is section called “FollowBlog via Email”
• In the space provided, type in your email id and click on the “Follow Blog” button (give your personal id, since companies often block wordpress)
• You will get a message for confirmation at that email id
• In the email there is a clickthrough link for confirmation – click on it and complete the formalities

Green IT

“What is Green IT? Should I invest my time learning about it?”, these are some questions typically asked by participants in conferences and workshops involving process and quality folks.

Here are some pointers:

• The British Computer Society (BCS) has established a 3 day Foundation Certificate in Green IT in association with Information Systems Examination Board.
• The 3 day course ends with a 1 hour examination, which contains multiple-choice questions
• The course (and the exam) focuses on (1) How IT can help greeni-fy its other operations, and (2) how IT operations can be made more green
• Topics include disposal of hazardous waste, resource conservation and sustainable working practices
• The participants are expected to become familiar with (1) various protocols, panels, summits, and international frameworks on Climate Change, and  (2) legislation and standards like ISO 14001, Energy Star, EPEAT and WEEE
• Internal assessment of an organization’s Green IT status and action planning are other topics covered in the course

The syllabus has been published here.

You can get more information from the following:

• British Computer Society
• QA Ltd.