The Checklist Manifesto: How to Get Things Right

the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form.

people can lull themselves into skipping steps even when they remember them.

we have just two reasons that we may nonetheless fail. The first is ignorance—we may err because science has given us only a partial understanding of the world and how it works.

It is the complexity that science has dropped upon us and the enormous strains we are encountering in making good on its promise.

Here, then, is the fundamental puzzle of modern medical care: you have a desperately sick patient and in order to have a chance of saving him you have to get the knowledge right and then you have to make sure that the 178 daily tasks that follow are done correctly—despite some monitor’s alarm going off for God knows what reason, despite the patient

checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized.

The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory.

The second type of failure the philosophers call ineptitude—because in these instances the knowledge exists, yet we fail to apply it correctly. This is the skyscraper that is built wrong and collapses, the snowstorm whose signs the meteorologist just plain missed, the stab wound from a weapon the doctors forgot to ask about.

Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail.