{"id":347,"date":"2024-09-10T18:02:09","date_gmt":"2024-09-10T18:02:09","guid":{"rendered":"https:\/\/permutationcity.co.uk\/bp\/?p=347"},"modified":"2024-09-13T16:28:20","modified_gmt":"2024-09-13T16:28:20","slug":"the-checklist-manifesto","status":"publish","type":"post","link":"https:\/\/permutationcity.co.uk\/bp\/2024\/09\/10\/the-checklist-manifesto\/","title":{"rendered":"The Checklist Manifesto"},"content":{"rendered":"\n

The Checklist Manifesto<\/a> is a book from 2010 by author Atual Gawande<\/a>, an American surgeon and public health researcher. I read it a while ago and it reinforces my belief that we all make mistakes<\/a>. Unsurprisingly the book is all about checklists. It may not sound like much it can be a great help in reducing mistakes. The book takes us through a number of real world examples. He talks to builders, pilots and doctors in order to learn how to make surgery safer. I do recommend it in full but I’ll take you through it quickly.<\/p>\n\n\n\n

Building a skyscraper<\/h2>\n\n\n\n

In the past when you wanted make a big build, a cathedral say, you would hire a master builder.\nIt would be one persons responsibility to design, engineer and oversee the construction.\nOver time buildings have gotten larger and more complicated.\nArchitecture and engineering split of from construction.\nThen further splits until there are specialisations everywhere.\nAll of these people have to work together.\nThe different system they are responsible have to fit together.\nThere is too much for a single master builder to oversee and\nso they have to look for another way to coordinate.<\/p>\n\n\n\n

The author is shown the construction schedule for one building.\nIt lists line-by-line day-by-day what needs to be done.\nThe concrete floor to done on this day, the steel to be delivered the next.\nColour coding shows critical steps.\nUpdates are made on a computer but printed out weekly, more often when it’s busy, and\nposted up on the wall so everyone can see it.<\/p>\n\n\n\n

Not that everything always follows this plan. All buildings are expected to settle somewhat during construction. With the building in question this has happened faster than expected and unevenly. Water is pooling on the floor of one of the upper floors. So an update must be made. At a minimum clean-up is required and the schedule adjusted. More importantly, is it a serious construction defect and, if so, what is to be done about it? A new communication checklist is created specifying who has to talk to who, about what, and what date it must be done by. While the initial plan is never going to be perfect it can be review and update, indeed it is expected that it will be.<\/p>\n\n\n\n

Flying a plane<\/h2>\n\n\n\n

Individual aircraft accidents hold a lot of attention.\nAs a consequence a great deal of effort is put into flying safely.\nDespite any fears of flying it really is one of the safest ways to travel.\nA typical airline pilot will trained, fly for years, perhaps their entire lives,\nwithout experiencing a major incident.\nYet they still have to be able to react immediately and correctly if something goes wrong.\nThat doesn’t just happen.<\/p>\n\n\n\n

In the cockpit of each plane there is a handbook, different depending on the type of plane and perhaps the airline. The first few pages are a series of checklists detailing normal operations: before starting engines, before pulling away from gate, before taxiing to the runway and so on. A pilot may have done these actions thousands of times. However familiarity can lead to complacency. These checklists are a reminder of what must be done. The rest of the book is a great many checklists detailing non-normal operations: smoke in the cockpit, different warning lights, dead engine, disabled copilot, etc. A pilot may have experienced some of them, may have trained for some, and other will be new. With potentially hundreds of lives on the line they must be able to follow the correct procedure. These checklists are that procedure. Importantly if there is an accident, there will<\/em> be an investigation. An investigation will lead to a report which, if necessary, can lead to the checklists being updated.<\/p>\n\n\n\n

Using central lines<\/h2>\n\n\n\n

A central line<\/a> is a catheter placed into a large vein. It is frequently needed when treating critically ill patients to take blood or administer drugs without the need for repeated needle punctures. However the central line itself carries a risk of infection. To avoid infection when putting in central lines a doctor should:<\/p>\n\n\n\n