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UPDATED: 3/30/20 - 1:28 p.m.

"The Checklist Manifesto"

checklist.jpg2012 Summer Reading Assignment: checklist manifesto by Atul Gawande

A committee of faculty, staff, and students has recommended Atul Gawande's The Checklist Manifesto as the Common Summer Reading for the students entering Catawba College in fall, 2012. The Checklist Manifesto focuses on how humans can avoid making costly and dangerous errors in an increasingly-complex technological society. The book relates several real-world examples from medicine, construction, and aviation, and includes an account of USAirways flight 1549 that shows how checklists and teamwork contributed to the plane's miracle landing on the Hudson River.

The Checklist Manifesto meets several goals of the First-Year Experience. Not only is the book loaded with fascinating stories, but it will appeal to incoming first-year students because it is optimistic, fast-paced and relevant to their daily lives. More importantly, the committee found that The Checklist Manifesto affords discussion of deeper questions about human nature and our essential fallibility, particularly in situations where making errors by failing to use available information has serious consequences. Checklist also highlights some invaluable lessons: that some difficult problems can be solved with inexpensive, non-technological solutions; that teamwork more often than not is the best approach to solving complicated problems; and that heroism is often a function of being prepared. Such discussions — especially those focused on teamwork — fit well in conversations about our role as citizens and ties to our communities.

Moreover, Checklist can easily connect to the themes of many first-year seminars that will be offered, in addition to the argument that checklists are excellent devices for any and all people engaging in complex tasks. We hope our first-year students will find checklist-making to be a good skill to develop as they begin their college career. Finally, The Checklist Manifesto as the summer reading affords potential co-curricular fall activities for our students, as they could potentially hear from people in disparate fields who offer their observations on uses of checklists.

About the author: Atul Gawande is a surgeon, a professor at Harvard Medical School, and a staff writer with the New Yorker. He is also the author of Better and Complications.

Study and Reading Guide

How to Use the Study Guide
The following is a comprehensive guide to assist you in gleaning important facts and ideas from The Checklist Manifesto. Your First-Year Seminar Advisor will, in his or her letter to you this summer, explain to you how to focus your reading for the particular questions that will be the basis of your seminar's discussion and use of the book during Orientation and the fall semester.

Before you read: Find out something about the author, Atul Gawande. What is his background? What is his ethos? What do we mean by ethos? Why do you think he wrote this book?


  1. What is the essential lesson or "takeaway" from the account of the seemingly-simple ER stab wound case? Of the case of the man who "flatlined" while undergoing surgery for his tumor?
  2. What is the principle of necessary fallacy? Why do we fail?
  3. What are the problems with "eptitude"?
  4. What is the paradox of gained knowledge and technology?
  5. What may be the answer?

Chapter 1: The problem of extreme complexity

  1. Why is the care of the nearly-drowned child special?
  2. Just how complex is "standard medicine"? (see 19, 21, 23) How does Tony DeFilipo's story exemplify the complexity?
  3. Why is medicine specialized?

Chapter 2: The checklist

  1. What were the circumstances that led to the pilot's checklist?
  2. Why might "simple" be better than "complex," particularly for experts reluctant to use simple lists?
  3. What was the Keystone Initiative, and why did it work despite hospital staff misgivings?
  4. What is the essential reason that checklists improve performance?

Chapter 3: The end of the master builder

  1. What's a cognitive net?
  2. What are three types of problems? Can checklists help with "forming functions" or simple problems? How are complicated and complex problems different?
  3. How does Gowanda show that checklists can help with complicated and complex problems?
  4. What happened to master builders?
  5. What wisdom does Joe Salvia have for Gawande, and what surprising lessons did Gowanda learn from him?
  6. What is the importance of the submittal schedule?
  7. Who gets to find problems — and what happens when they do?

Chapter 4: The idea

  1. What's the importance of diffusing decision-making?
  2. How did the traditional model of decision-making work after Hurricane Katrina?
  3. Why did Wal-Mart succeed when the government did not?
  4. How do checklists "balance a number of virtues"? (79)
  5. What other people (surprisingly) use checklists? How are they used? Why are they used?

Chapter 5: The first try

  1. What's the WHO, and why was their request to Gawande a "prop"?
  2. How impossible did Gowanda see the task of helping WHO? Why was he wrong?
  3. What were (are) some of the treatment problems that Gowanda articulated?
  4. Why are simple interventions so potent? Why is plain soap "leverage"?
  5. Antibiotic training — why were people resistant?
  6. What was the importance of the placement of "cleared for takeoff"?
  7. Why are talking and briefing so important? Why is talking among team-members "non-standard"?
  8. Teamwork: why is it so hard? What happens when people "click"? (see, for example, 105-107)
  9. Is success just a matter of luck? What's the activation phenomenon? The pause point?

Chapter 6: The checklist factory

  1. Who is Daniel Boorman? Why is he an aviation checklist guru?
  2. How does the DOOR FWD CARGO checklist work?
  3. What are the elements of good checklists, and why should "desk jockeys" not be allowed to aid in their development? These elements are articulated across several pages; be sure to note differences b/t READ DO and DO CONFIRM lists
  4. How did Gawande's flight simulator experience show the best practices of checklist making?
  5. What was the lesson from Flight 38 from Beijing to London? From the flu vaccine? (133; pneumococcus vaccine).

Chapter 7: The test

  1. There are several reasons that the person who is in charge should not be responsible for the checklist. What are these reasons?
  2. How are pause points important in these instances?
  3. How did certain items ultimately end up on the surgical checklist? What criteria were essential?
  4. How did Gawande's team decide where and how to check the checklists?
  5. What happened when tracking six basic steps?
  6. Why must the checklist be "top down"?
  7. How were the eight hospitals in Gowanda et al.'s study different — and how did those differences affect the checklists?
  8. What were the informal results of checking the checklists? The formal (actual) results?
  9. What were the various responses to the study's results?

Chapter 8: The hero in the age of checklists

  1. What is the real cultural "big deal" about using checklists? (160)
  2. How is rock-star status a detriment to getting the job done?
  3. Warren Buffet and other high-roller investors managed to avoid "cocaine brain" and have more successes than failures. What lessons did they learn from their successes? From their failures?
  4. How did Cook's checklist improve both speed and efficiency?
  5. What are art critics, spongers, prosecutors, suitors, terminators, and airline captains in investing?
  6. How do checklists conflict with the image of a hero?
  7. How did USAirways Flight 1549 show that real heroes use lists?
  8. Who REALLY saved the people of flight 1549?
  9. What are the key elements of professionalism? Where does discipline vs. autonomy fit?
  10. What are the components of systems, and where do systems break down? Why don't we know how systems break down?

Chapter 9: The save

  1. Why was Gowanda using the surgical checklist — really?
  2. What sorts of problems did the lists catch?
  3. What happened to Mr. Hagerman?
  4. Why did Gowanda end his book with this story? Does Gawande's "failure" make him a better person? Surgeon? Story-teller?