1.
Checklist Manifesto
How a checklist can boost efficiency and reduce mistakes

2.
Atul Gawande
American surgeon, writer, and
public health researcher.
Practices general and endocrine
surgery in Massachusetts.
Author of The Checklist
Manifesto, Being Mortal,
Complications, and Better.
Source: https://en.wikipedia.org/wiki/Atul_Gawande

3.
“The volume and complexity of what we know has
exceeded our individual ability to deliver its benefits
correctly, safely, or reliably. Knowledge has both
saved us and burdened us.”
- Atul Gawande

4.
Two Reasons of Failure
1. Ignorance- Science has given us only a partial
understanding of the world and how it works
2. Ineptitude- Knowledge exists yet we fail to apply
it correctly

5.
Examples in Healthcare
• Ignorance- In the 1950’s, heart patients were put on bed
rest for weeks in order to avoid strain to heart
• Ineptitude- In 2006, only 50% of hospitals achieved
proper testing for heart attack patients undergoing
cardiac balloon therapy that needed completion within
90 minutes after arriving at hospital

6.
Checklists can fill
the gap between
error and
success rate

7.
“The checklist cannot be lengthy. Keep it
between five and nine items, which is the limit
of working memory.”
- Atul Gawande

8.
PATIENT HAS CONFIRMED
• IDENTITY
• SITE
• PROCEDURE
• CONSENT
SITE MARKED/NOT APPLICABLE
ANAESTHESIA SAFETY CHECK COMPLETED
PULSE OXIMETER ON PATIENT AND FUNCTIONING
DOES PATIENT HAVE A:
KNOWN ALLERGY?
NO
YES
DIFFICULT AIRWAY/ASPIRATION RISK?
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE
RISK OF >500ML BLOOD LOSS
(7ML/KG IN CHILDREN)?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS
AND FLUIDS PLANNED
NURSE VERBALLY CONFIRMS WITH THE
TEAM:
THE NAME OF THE PROCEDURE RECORDED
THAT INSTRUMENT, SPONGE AND NEEDLE
COUNTS ARE CORRECT (OR NOT
APPLICABLE)
HOW THE SPECIMEN IS LABELLED
(INCLUDING PATIENT NAME)
WHETHER THERE ARE ANY EQUIPMENT
PROBLEMS TO BE ADDRESSED
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE REVIEW THE KEY CONCERNS
FOR RECOVERY AND MANAGEMENT
OF THIS PATIENT
SIGN IN
CONFIRM ALL TEAM MEMBERS HAVE
INTRODUCED THEMSELVES BY NAME AND
ROLE
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM
• PATIENT
• SITE
• PROCEDURE
ANTICIPATED CRITICAL EVENTS
SURGEON REVIEWS: WHAT ARE THE
CRITICAL OR UNEXPECTED STEPS,
OPERATIVE DURATION, ANTICIPATED
BLOOD LOSS?
ANAESTHESIA TEAM REVIEWS: ARE THERE
ANY PATIENT-SPECIFIC CONCERNS?
NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
CONFIRMED? ARE THERE EQUIPMENT
ISSUES OR ANY CONCERNS?
HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE
TIME OUT SIGN OUT
Before induction of anaesthesia Before skin incision Before patient leaves operating room
SURGICAL SAFETY CHECKLIST (FIRST EDITION)
Atul Gawande’s Surgical Checklist used to reduce
morbidity and mortality in the Global population

9.
“Good checklists are precise. They are efficient,
to the point, and easy to use even in the most
difficult situations.Good checklists are, above
all, practical.”
- Atul Gawande

10.
Benefits of Checklists
üEnsures consistency
üUsed to reduce failure
üAids in memory and
üInformational aid
üCompleteness when
attention
carrying out a task

11.
How Healthcare Checklists have Improved

12.
https://www.goodreads.com/author/quotes/3078.Atul_Gawande?page=5
5-Point checklist
reduced line infections from
10% to 0

13.
“One essential characteristic of modern life is that
we all depend on systems—on assemblages of
people or technologies or both—and among our
most profound difficulties is making them work.”
- Atul Gawande

14.
In the Workplace…
üEmployees feel
accountable for
performing inspections
because there is a
written record
üWorkers feel organized
when provided guidelines on
inspections

15.
“Just ticking boxes is not the ultimate goal.
Embracing a culture of teamwork and
discipline is.”
-Atul Gawande

16.
Source: https://inspectioneering.com/content/2016-
05-23/5360/instilling-a-checklist-culture-to-improve--
asset-integrity-manag
Facility Checklist Benefits
Process Reliability- Tasks
completed correctly the first
time decreasing re-work
Verifiable Compliance-Target
specific steps of a process for
improvement increasing worker
accountability and quality
assurance
Operational Insight- Discover
asset data to identify and
correct non-productive time and
improve on cost
Best Practice Capture- Identify
what’s working in facility and
replicate increasing production
efficiencies

17.
Could Your Industry Benefit from a Checklist?

18.
“We know the patterns.We see the costs. It’s
time to try something else. Try a checklist.”
- Atul Gawande