Tuesday, April 10th, 2012
the checklist manifesto

In 2009, Atul Gawande published The Checklist Manifesto:  How to Get Things | His website includes reviews, interviews, and even copies of some checklists.  Sometime later, a copy arrived at my office courtesy of a money manager, but it sat unread for many months.

I shouldn’t have waited and, if you haven’t read it, neither should you.  I knew of Gawande from his articles in The New Yorker, but despite the favorable notices I read when the book was published, I really didn’t expect much.  Checklists?  OK, right.

When reading it I was reminded how you can get ideas out of a good book that are found somewhere between its content and your experience.  As it turned out, the process of making investment decisions was a topic toward the end of the book, but by then I had lots of notes about how the use of checklists might be applied to good effect in the organizations that I study and advise.

As a result, my take is a bit different from the reviews that I’ve seen from other investors.  They have focused on the use of checklists for security selection, as if an individual is making the decision and ticking off the items to review and consider.  And with good reason, since doing so is likely to add value by making the process more disciplined.  My perspective is somewhat different, in that I see the promise in the much more difficult task of trying to improve organizational behavior and decision making.

Not surprisingly since Gawande is a practicing surgeon, his book features a number of medical examples.  A notable one involved the insertion of central lines in the veins of patients.  It is a common procedure with a few simple instructions for those conducting it.  Yet, for one reason or another, steps were routinely missed when done from memory rather than a checklist.  The use of one led to amazing reductions in the rate of infections, the number of deaths, and the total cost of care, “all because of a stupid little checklist.”

The biggest impediment to such dramatic improvements?  How we think about who does what.  “Charts and checklists, that’s nursing stuff — boring stuff. They are nothing that we doctors, with our extra years of training and specialization, would ever need or use.”

But it takes a team to do an operation, to build a building, and to make investment decisions in an organization.  Who should do what?  Is there “nursing stuff” and “doctor stuff” — and specialists that can’t communicate with each other — or is there a cohesive, well-constructed team that is motivated to solve problems?

Gawande uses several examples from the history of flight throughout the book.  Early in the development of commercial aviation, accidents caused by human error were common, even among experienced pilots.  But over the decades, the culture of aviation has changed from one of swashbuckling to one of the checklist.

When a US Airways flight taking off from La Guardia hit a flock of geese, crippling the engines, the pilot (who had not been flying the plane) said simply, “My aircraft.”  The co-pilot responded, “Your aircraft.”  They had never flown together before, but thus commenced a methodical, by the book (or should I say checklist?) process in the cockpit, which was matched by the flight attendants in the passenger cabin.  You know the rest of the story — the most famous landing in history took place in the Hudson River.

Tomorrow:  On “expert audacity” and the culture of investment firms.the research puzzle | This PDF has the list of the postings in the series.