The Checklist Manifesto, is closer to the main line of his writings. In this short book, presents his argument that medicine as currently practiced is far from a rigorous, science-driven field. He shows how aviation and construction are at least as complex and time-constrained as medicine, and that both have benefited from the use of checklists to help practitioners get the details right when performing complex operations.has been writing on medical practice, provocatively and informatively, for the New Yorker for several years. His comments on price differences and what drives disparities between different areas garnered a lot of attention, but that area hasn't been his main focus. His recent book,
Individual errors and mistakes of coordination are far more common in medicine than in other modern highly-technical fields. If medicine followed the standards of professional practice common in other areas, there would be a dramatic improvement in our overall health.discusses how checklists are constructed and used in aviation, another field where routine work is occasionally suddenly interrupted by situation requiring split second decision making at a rapid pace in a distracting environment with enormous consequences. Safety experts in aviation have learned how to put together checklists that can be found quickly, and that enable professionals to correctly address situations that arise in one flight in a million.
The safety record in aviation world-wide is amazingly good. I've long ascribed that difference between aviation and medicine to the fact that accidents in aviation are scrutinized thoroughly, and every mistake drives new corrective processes that quickly make it less likely that the same thing will happen again anywhere in the world. Every airframe manufacturer ensures that all of its vehicles are quickly updated with the most up-to-date procedures. In medicine, individual hospitals sometimes conduct reviews, but any knowledge gained is used sporadically and locally. There is also no standard for how to conduct these inquiries, so some investigations are derailed by politics, infighting, or a desire to deflect blame (which is exacerbated by medical malpractice risks.) The inquiries conducted in aviation have been designed to find correctable causes, and not to place blame. Focusing on the checklists that result from these inquiries would be a big improvement on what we have in medicine now. It's even plausible that a coordinated process for producing checklists would drive an improvement in the checklists based on measured effectiveness.
The book is very readable. The main story is about howled a task force for WHO testing out some simple checklists for a few common surgical procedures with high rates of routine errors. The results were spectacular, leading to a 36 percent reduction in complications and 47 percent drop in deaths from a variety of hospitals in rich and poor communities all over the world. Getting doctors and hospitals to actually adopt this simple improvement is a far harder task than getting a pilot program demonstrating its effectiveness. The side trips makes into aviation and construction to show how checklists work there and how they're constructed are engaging.