The document outlines 15 steps to screw up the ability to deliver database schema changes. It describes anti-patterns such as fearing every change, not using source control processes, imposing new processes without training, and hot-fixing problems in production. It also provides alternatives such as embracing change carefully, adopting DevOps early, using standard source control processes, providing training, and avoiding production hotfixes. The document is authored by Alex Yates of DLM Consultants.