In 2006, US surgeon Atul Gawande was asked by the World Health Organisation to develop a global programme to reduce avoidable deaths and harm from surgery. His answer was to produce a very basic 19-point checklist to perform in theatre before and after operations. The result? Hospitals around the world saw major complication rates post-surgery fall by -36%, while deaths dropped by -47%.
The Checklist Manifesto is a homage to the simple art of making and following lists. Gawande’s surgical checklist was inspired by the aviation industry where the benefits of lists have been long understood, allowing pilots to get things right when stress, fatigue or information overload might otherwise lead to simple mistakes.
Gawande argues that checklists are useful for any endeavour that requires the mastery of complexity and/or large amounts of knowledge. They act as a ‘cognitive net’, catching mental flaws inherent in all of us – flaws of memory, attention and thoroughness. Gawande briefly discusses checklists in investment, and their benefits when used as an aide-memoire for adhering to one’s investment process through thick and thin.
Gawande is realistic, though, about the limits of a checklist. They will not work if they are too long or vague. And, as he puts it, ‘a checklist will not fly a plane’, however useful these lists have been to the aviation industry over the years. But perhaps the biggest challenge for a checklist is its adoption in the first place. In Gawande’s words: ‘It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to our deep-held beliefs about how the truly great among us – those we aspire to – handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating.’
Hugh Yarrow is investment manager at Wise Investment