![]() ![]() ![]() His book also discusses the use of checklists by pilots, in particular the role that following checklists played in the safe water landing of US Air flight 1549 by Sully Sullenberger. The value of the checklist goes well beyond the hospital. Once a checklist was introduced and implemented, the rate of infections decreased by 66% and at some hospitals to zero. He cites a December 2006 article in the New England Journal of Medicine describing a project in Michigan to reduce central line infection rates at hospital ICUs. His point is that by itself specialization cannot overcome medical complexity and the need to take the specific steps required to avoid problems such as infections. But even with this super specialization upwards of 150,000 surgery-related deaths occur each year, half of which are avoidable. Gawande writes concerning surgery that the response to complexity has been to have doctors move from being specialists to super specialists. His solution is the checklist, which he readily admits will appear “almost ridiculous in its simplicity” to some of those who have developed “more advanced skills and technologies.” And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.” Within financial services, banks operate today with increased complexity related to analysis, products offered, compliance requirements, and investor involvement, among other areas. Avoidable failures are common and persistent… across many fields - from medicine and finance, business to government. In the book’s opening chapter he writes of the tremendous knowledge we possess in the twenty-first century (in areas well beyond medicine) and the difficulty involved in managing that information: “We have accumulated stupendous know-how… Nonetheless, that know-how is often unmanageable. It provides one of the most straightforward and practical approaches for managing difficult situations, the often ignored and unappreciated checklist. The Checklist Manifesto: How to Get Things Right is a best seller written by Atul Gawande, a surgeon. ![]()
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