The Checklist Manifiesto: The End of the Master Builder

(Our weekly reading according to our reading calendar)

The benefits of using checklists of simple task are obvious. However, the author ask himself it they can be also beneficial when tackling complex tasks, that is, tasks with lots of different actions to be taken and with unexpected and unforeseeable complications. The kind of environment that he has previously shown us that is the norm in modern medicine.

To look for answers he turns to the building construction industry. Building big skyscrapers is an extremely complex task that involves the coordination of hundreds of workers and specialists. It seems, like the intensive care units of hospitals, the perfect kind of environment for mistakes to easily appear. And however they don’t. Building collapse is an extremely rare event. The building industry manages quite well the complexity.

Until the twentieth century, the construction of a building was organized and managed by the Master Builder, and experienced expert who took responsibility of all the critical decisions and steps of the building process.

During the last 100 years this figure has disappeared. The job is nowadays organized in a mechanical way around two kinds of procedures. On one side, there is a checklist-like amount of documentation that describes the planning of the building process and which is constantly checked by all parts for consistency and accomplishment. On the other side, there is also a clearly defined documentation that defines the steps of communication between different participants that have to be performed when unexpected events happen.

In the author’s opinion, medicine has still to make the step out of the master builder stage like the construction industry did almost a century ago.


3 thoughts on “The Checklist Manifiesto: The End of the Master Builder

  1. Pingback: A few tips on project management | Inter News

  2. Thank you for the summary, Carlos. Clear and to the point.
    I like how Gawande is building his argument, step by step: first he described us the many problems and complexities in our modern world. Then he presented the checklist in his most humble form,as a way to remember basic steps to solve a simple problem and not forget any of them. Now in this chapter he shows us how checklists are the solution to the very complex problem of building a skyscrapers. The numbers are astonishing:
    “In the United States, we have nearly five million commercial buildings, almost one hundred million low-rise homes, and eight million or so high-rise residences. We add somewhere around seventy thousand new commercial buildings and one million new homes each year. But “building failure”—defined as a partial or full collapse of a functioning structure—is exceedingly rare, especially for skyscrapers. According to a 2003 Ohio State University study, the United States experiences an average of just twenty serious “building failures” per year. That’s an annual avoidable failure rate of less than 0.00002 percent.” (p. 71)
    I also liked the division of problems into three basic types: (p 49): simple problems (which can be solved by repeating a single algorithm) the complicated problems (which are solved by dividing it into lots of simple problems and tackle them step by step) and the complex problems (that are so sensible to the environment and context that every instance of the problem is different and has to be analyzed and solved in an specific way)

  3. Pingback: The checklist manifesto: The Idea | El Pla Subtil

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