Atul Gawande, The Checklist Manifesto

[sanguinity]

17. Atul Gawande, The Checklist Manifesto.

While listening to this, I somewhat snarkily retitled it, "Atul Gawande Reinvents Project Management, Quality Management, and Human Factors, In the Most Credulous and Irritating Way Possible." That was despite also thinking, "Y'know, this could conceivably maybe perhaps be added to the Project Management curriculum, even as informal and gee-whiz as it is: it's readable, it clearly lays out the why, and in some ways it behaves like a series of case studies ready-made for class discussion. It could be particularly useful if you're trying to run a Project Management class in a curriculum that doesn't traditionally do Project Management: 'Project Management for Poets', so to speak."

...of course, that latter bit -- an intro to Project Management for a discipline that doesn't do Project Management -- is precisely what the book was intended to be. In the interest of being fair: it does it pretty well, too.

However, if, as a reader, you've had formal coursework in both project and quality management, worked in an industry that not only takes those disciplines as a given, but breathes "standardization and repeatability are necessary prerequisites of quality" as a functional motto, if you've been partly responsible for maintaining ISO 9000 compliance, or if you've spent months revising and field-testing and fine-tuning emergency-response checklists (and yes, font and color choices matter, because you're trying to triple-code information in a way that improves cognitive processing speed -- in the face of adrenaline, even!)...

...well, you might find yourself yelling at the page, "Gantt Chart! Gantt Chart! Just say it already! It's called a Gantt Chart!"

Ahem.

I think what really hit my buttons about this one was the implied professional disrespect that surgeons, as a group, appear to feel for... well, everyone else. It's as if they're the only people in world who have complicated, high-stakes jobs, where people might die if they screw up. Hello, surgical profession? When engineers screw up, we sometimes kill people by the dozens. Or even hundreds. (I do not wish to discuss thousands.) That we do so only infrequently is not a sign that the potential isn't there, or that we are professionally lesser; it's a sign that, as a field, we've admitted that we are merely human, with merely human cognitive capacities, and figured out ways to do things that do not rely on individual superheroism. In other words, we are more mature than you, surgeons. Maybe all y'all should think about growing up someday.

(To be clear: Atul Gawande seems to respect other professions just fine. He's certainly willing to say, "Huh. It seems I don't magically know how to do this. Maybe I should go talk to some professionals in another field." (Even if he does spend lots of time going, "Huh. I guess this thing that those other professionals do is actually hard. Who knew!?"))

Yeah, I dunno. It just got up under my skin, is all. If you haven't worked in a field that treats project and quality management as formal disciplines, The Checklist Manifesto may be a perfectly satisfactory read. Hey, you'll probably even learn a number of the principles of project and/or quality management! (Hey, watch me engage in professional snobbery now: most fields could greatly benefit from knowing and using those principles.)

Or maybe my grumbliness is merely professional envy that Gawande got to interview the flight checklist designers at Boeing. Fucking rockstars, those people are.

Comments

[jinian.livejournal.com]

Ha! I've really enjoyed the Gawande I've read, but this one did not appeal to me despite my lack of project management background. Like, yes, checklists are good, they work; moving on. Actually, it seems like a lot of what he was saying, in Better IIRC, was in fact that surgeons are immature. Maybe this one was for the surgeons to read and not throw a tantrum about?

[sanguinity]

:: Maybe this one was for the surgeons to read and not throw a tantrum about? ::

Well, that would be the mature thing to do... ;-)

[jesse_the_k]

MyGuy was Quality Manager for Southcentral Wisconsin's largest HMO for almost two decades (with formal training in I.E., process control, statistics &c.) in charge of analyzing why "adverse events" ocurred and how to prevent them.

His Gawande opinion was very close to yours. But, he adds, of course docs are of the opinion that, as a rule, they're smarter and better educated than anybody. For some reason it didn't obtain universally in MyGuy's case, because some docs were awed that he'd made it through thermodynamics.

[sanguinity]

Every time I went to a conference of safety pros, word on the ground was that doing safety (or quality -- there's a big concepts and methods overlap between the two) for medical institutions was the most thankless set of jobs in the profession, rivaled only by doing safety for academic institutions. Twenty years? I'm impressed.

:: ...because some docs were awed that he'd made it through thermodynamics. ::

Ha!

Yanno, the last couple of doctors and doctors-in-training I've talked to about these things volunteered that they were ignorant of, and woefully uneducated in, everything that outside of medicine, and even most medicine outside their own specialties.

But I suspect that from a doctor's perspective, the question of "how to make medicine safer" would seem to be a within-medicine knowledge set, not a cross-disciplinary knowledge set.

...which brings us straight back to "woefully uneducated in things that are not medicine", but there you are.

[chomiji]

I thought it was a fairly interesting book, but it did read like a feature article that had been unnaturally stretched to book length.

[sanguinity]

Heh. For me, it was a "Greatest Hits" of several different disciplines. Not so much compressed or stretched beyond a natural length, but more like a skipping stone: glancing in and out of topics as if the breadth and depth of the lake didn't exist.

To be fair, I don't exactly expect a popular book aimed at a lay audience to tackle the full depth and breadth of these topics. But it is odd to see not even a nod of acknowledgment that the lake exists. I'm not sure he does know it exists.

[chomiji]

I had a feeling as I was reading it that - perhaps because of the specialized route that most doctors take through their educations - a lot of this was really new to him, and he thought it would be new to a lot of his readers. But it does also have a sort of cursory feel to it, like he felt he'd already spent enough time on it and didn't want to go into more depth.

For me the most interesting thing was not the idea of having the checklist at all - because that's kind of obvious - but the puzzle of how to optimize the items on it to balance between something that would actually make a difference and something that was still short enough that people would bother to use it. That's a fascinating psychological issue to me.

The book also had a certain urgency to it because my daughter was scheduled for potentially dangerous surgery (her jaw had to be taken apart and re-shaped, with risks of nerve damage, bone infection near the brain, etc.) at about the time I read it. It was interesting, sitting with her while they were waiting to take her back, and seeing the charge nurse do that sort of series of checks.

[rsadelle]

Huh. That's an interesting perspective. I couldn't get into the book at all. Part of it was that I wasn't in the mood to read it at the time. Part of it, though, was that I had read The New Yorker article version and found the beginning of the book too repetitive. The article is from 2007, which is early enough that it's entirely possible that he did stretch that into a book.

[chomiji]

I hadn't read his original article on this topic, but I had read a couple of other essays by him, which is what made me think of that.

[pauraque]

It is very difficult to read a popular book on a subject you have a deep understanding of. Everything in that book was news to me, so I enjoyed it!

[sanguinity]

Oh, I am sincerely glad. After all, many of the things he talked about are ideas that are dear to me (if they hadn't been, I wouldn't have been so yelly about his "Huh, this is hard, who knew?"), and he does do a nice job of summarizing some important ideas. So, yay.

And yeah, I went back and reread your review of it: I so agree with you on who I would rather have doing my surgery!

[holyschist.livejournal.com]

I liked the case studies, but I am not a project manager! On the other hand, I get very grumpy about most popsci books in my field, so I'm not surprised it frustrated you.