Atul Gawande, The Checklist Manifesto, and the Value of Humility

If you haven’t read any of Atul Gawande’s essays or books, I highly recommend them. While, as a surgeon, his writing is generally grounded in the practice of medicine, the topics he writes about have much wider applicability. Specifically, I just finished The Checklist Manifesto, which argues persuasively a deceptively simple premise: people in a wide variety of fields could reduce their rate of errors, be more effective, and prevent catastrophe through use of the humble checklist. If you read it, you’ll find yourself wondering why the practice isn’t more widely used.

Is it simply because we’re too proud to admit that we could use the help?

As Gawande points out in The Checklist Manifesto, certain professions would find this question a little silly; they live and die by checklists. Skyscrapers and major building projects couldn’t get built (or remain standing) without careful coordination between dozens of trades; the only way to coordinate them is to keep everybody on the same page by–you guessed it–relying on a checklist. And pilots rely on checklists for nearly everything. It was the development of a checklist that turned Boeing’s B-17 from an unflyable disaster into the plane that helped win World War II. Inspired by these examples, Gawande tells the story of how he and a group from the WHO developed a checklist to reduce the number of surgical errors. (His concise description of what makes a good checklist is worth the price of admission alone.)

But convincing surgeons to sign on isn’t always an easy task; some surgeons bristled at the idea of having to go through a checklist of obvious steps, or of exposing themselves to being corrected by people lower than them on the chain of authority. This discussion reminded me of another excellent Gawande essay, in which he discusses the usefulness of coaching, even for professionals whom we think of as already “trained.”

To accept coaching, however, unless it is forced upon you, requires a specific mindset: humility. To a certain extent, this is a function of the fundamental attribution error, or as Gawande describes it:

This is why it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?

I have spoken to other surgeons about the idea. “Oh, I can think of a few people who could use some coaching” has been a common reaction. Not many say, “Man, could I use a coach!” Once, I wouldn’t have, either.

But there is a critical difference between humility and a failure of self-confidence. To accept coaching, especially in such a public way, is to expose oneself to the judgment of others. The judgment that you are seeking help not because you are good and want to improve, but because you have fallen short and need to be remedied. The same goes with checklists: referring to a checklist may catch you from omitting a step or missing a deadline, but you have to be ready to accept that an outsider may see it as an admission of failure.

And so, those are the two questions Dr. Gawande has left in my head. Are we humble enough to know that we can be improved if we ask for help? Are we confident enough to ask for the help we need, even if somebody might see it as a sign of weakness?

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