This book has a very simple core message: using checklists in the right manner can save lives.
Approaching the checklist as a surgeon, Gawande leads the reader, through a logical narrative, to the value of such a tool and then the complexities of implementing it to good effect in the medical setting.
Firstly, he sets the scene for the issues faced in the profession by expounding the complexities of surgical specialities through anecdotes, to highlight that in modern medicine
‘now the problem we face is ineptitude…making sure we apply the knowledge we have safely and correctly’
Drawing from fields such as hospitality, construction, investment banking and aircraft piloting, the different functions of the humble checklist becomes abundantly clear in his carefully chosen examples.
Piecing together his research from other fields, Gawande shares the journey of the creation of the WHO’s ‘Surgical Safety Checklist’. Opting for a DO-CONFIRM format rather than READ-DO format, only including essentials and asserting that nurses should take the role of leading the checks, the checklist was finally complete.
The final analysis of the pilot study highlighted the effectiveness, as small mistakes such as administering antibiotics outside of the given time window or operating on the wrong side of a patient meant deaths fell by 47% among the 8 radically different research hospitals. Despite the different settings, one issue remained the reactions of the surgeons. Yet when asked if they would like the checklist to be used on the 93% said yes.
Gawande seems to suggest is the end of the master builder and the commencement of the era of the checklist.