Modern medicine has always been dependent on the rote memory of it's professionals. Some areas of medicine, surgery in particular, have recurring error rates that seem to be impossible to reduce. The errors are preventable; infection being the primary problem.
Checklist Manifesto is about Gawande's interest in applying aviation-style checklists to surgery.
He starts out with a few scary case studies of competent surgeons who made memory errors. He briefly discusses the history of the aviation checklist - The crash of the B-17 prototype on a demonstration flight (the gust lock was still engaged) was the impetus for Boeing to create a checklist for increasingly complex airplanes. Gawande visited Boeing's checklist guru to get an insider's view on checklist creation and application.
He then works as lead on a WHO task force to improve surgery outcomes throughout the world, in developed and very underdeveloped countries. They develop checklists, implement them, and change them with feedback. The entire process is quite fascinating, and the results were striking - a 30-50% decline in infection and complication rates across the board, developed and undeveloped countries.
His discussion of the philosophy of error-making really piqued my interest. An article by Gorovitz and MacIntyre about "necessary fallibility" summarized the problem:
Even if we have the capacity to control (some errors are due to things beyond our control), we may fail because of a) ignorance - insufficient knowledge, or b) ineptitude - failure to apply useful knowledge.Problems can be simple, complex, or complicated. The distinctions are important. (get book back to refresh) p.51.
An example of checklisting from the rock and roll world is David Lee Roth's "No brown M&Ms" clause buried in the Van Halen concert contract. The first thing they would do on arriving at a venue is go to the dressing room, which was contractually equipped with a bowl of M&Ms that was to have all the brown ones removed. If Roth found a brown M&M, it signaled that the promoter had not fully read the contract, and the band didn't know if they missed other very important safety items as well (load bearing limits on stage for example). They allegedly walked out on a venue after it failed the brown M&M test. p.80
Central line infection rates (p.27)
