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The Checklist Manifesto, a Book Review

Posted on February 17, 2010

One of my joys in life is finding good material for cross-discipline reading, and I found a lot of great stuff to digest in Dr. Atul Gawande’s work entitled “The Checklist Manifesto: How to Get Things Right.”

Dr. Gawande is a surgeon who has worked with the World Health Organization to study, craft and implement simple checklists as a precaution against surgical mistakes, complications, infections and deaths. This is a fascinating book written with humor and style. I owe a lot of thanks to the venerable Diane Rehm for having the author on her show recently and introducing me to the book. Diane rocks!

The book introduces some solid ideas for those of us in spiritual vocations to consider. I’ve made a short list of four big ideas and will add in a few quotes from the book. The ideas aren’t necessarily new, but definitely under-enacted in many of our professional lives and faith communities.

1. The Burden of Knowledge. Dr. Gawande touches on a huge problem facing many fields of science these days, not that we are ignorant, but that we actually know so much. He does not say we know too much, but points out that as our knowledge base has grown so much that we have begun to face more difficulty in assimilating the knowledge into consistent, accurate and dependable practice. He says it this way on page thirteen, “…the volume and complexity of what we know has exceeded our individual ability to deliver it’s benefits correctly, safely or reliably. Knowledge has both saved us and burdened us.”

If you’ve delved into the realm of theological studies then maybe you’ve also faced a frustration that has haunted me through the years: I can’t process all this stuff! I find that I cannot hold, in my sorry excuse for a brain, everything I need to know and remember about 2,000 years of Christian thought, much less what I add from thousands of more years of Jewish thought and all the other spiritual traditions of the world around me. So, can I create a model, even a checklist of sorts, to help me anchor a point from which I can operate in a daily way but also take deeper forays into the deeper realm of theology when needed activities and tasks arise? I’m both afraid and intrigued by such an idea, and to date I haven’t even tried to make such a list/process. The question may sound stupid and even primitive to you smarter folks, but the second point I’m pulling from the book may help you see how such a checklist would function.

2. The Cognitive Net. Dr. Gawande describes the checklist, not as a robotic brain-sucking, inanimate object that tells us what to do or what to think, but as a “cognitive net” that frees us to concentrate on the important, immediate stuff while not risking the important, yet peripheral things. He says on page 48 that such a checklist would “…catch mental flaws inherent in all of us – flaws of memory and attention and thoroughness. And because they do, they raise wide, unexpected possibilities.”

OK, that quote gets me a little excited. Not just in theological studies, but also in the weekly activities of a church family. In our daily tasks within the religious vocation we face a myriad of activities and responsibilities that present us with a combination of complexity, mind-numbing detail and often repetitiveness. What would a cognitive net for the full-time or part-time pastoral staff look like? Would we develop a set of checklists to get the main tasks of a week finished and to track the Sunday AM preparations? If so, what would such lists look like, and how would they be made accessible and function with us?

3. Team. One of the strongest points made by Dr. Gawande is the power of a team versus the strength of the single hero whom he calls the “audacious expert.” This is something that many disciplines have struggled to understand and implement. At Church in Bethesda we work toward valuing the team effort over the single expert’s audacity by creating a flat and participatory organizational structure and then implementing a visionary-consensus model of making decisions (no voting, only group think). We assume that the group can be more creative, wise and better equipped than any individual, no matter how trained and competent that individual might be. Such individuals are still important and needed, but are helped and made better by the group.

Dr. Gawande mixes this in with the concept of decentralizing power to better enable and empower the many members of a team (or community) to carry shared responsibility for solutions and outcomes. I like that idea, and I like what he says about building team in easy ways on page 108, in discussing the simple yet powerful idea of everyone speaking and being heard, even if just in giving their names: “The researchers called it an ‘activation phenomenon.’ Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and heir willingness to speak up.”

Really. How many times have we failed to emphasize the voice of every member of our faith communities? And I don’t just mean in business or ministry meetings.

4. Failure and Discipline. Dr. Gawande raises some very cool points to conclude the book. He begins by talking about a professional’s lack of discipline. I think I agree when he says that most helping/serving professions have a code of conduct, implicit or explicit, which emphasize the importance of selflessness, skill, and trust. He then adds a fourth that is often over-looked: discipline. He believes discipline to be much more difficult than the first three. Discipline is the commitment to process and procedure, the bane of any talented, driven, audacious and heroic leader, right? We want our heroes to be improvisational and amazing, not team players who can recognize and implement procedure and process to solve complex problems! Boring! But a new kind of hero is what many situations and problems most need.

Wow. This really frames a lot of angst in the church. We have and cherish the mythos of the charismatic, inventive, talented and unique pastor/leader/thinker/writer who stands alone, without peer, to break the path for us into new and exciting territory. We love and value the pastor/author/guru who can catapult us to the next level of coolness. St. John of the Cross, the Spanish mystic and poet of a bunch of hundreds of years ago, chastised this kind of thinking, a fevered dependence on the latest and greatest spiritual sermonizing and writing, as a pitfall for the spiritual adolescent. Dr. Gawande says on page 173: “Maybe our idea of heroism needs updating.”

Valuing both the audacious expert and the wisdom and power of the group can be a tough balance, but one that empowers a team/community to accomplish more and better action. He says succinctly on page 162 that “…good clinicians will not be able to dispense with expert audacity. Yet we should also be ready to accept the virtues of regimentation.” I think that it’s often either the over-regimentation or the lack of regimentation, a crucial imbalance, that holds some of our faith communities back from realizing their greatest impact in the world, locally and globally. What do you think? I’m intrigued and challenged by the question and it’s possible impact on how I do my job.

And finally, most of us aren’t too enthusiastic about really digging into our failures and the possible patterns that might be discovered, studied and changed. How many of us serving church congregations have reeled from job to job thinking, “Oh well, these folks just weren’t ready for me. One day I’m going to find a bunch of people who appreciate the greatness I bring to my profession!” Dr. Gawande points to the amazing process of and value placed upon investigating failures in the airline industry. No one else seems to come close to the kind of scrutiny they bring to bear on failures. Who would want to?

Still, if we are serious about the selflessness, skill, trust and discipline that come along with our professional and spiritual responsibilities, we must stop and do the scary work of poking around in our painful pile of failures. The hero, the audacious expert doesn’t often do this… that individual is expected to be above failures. To have a failure, it is thought, is to be a failure. Seriously, look at the professionals around us in just the field of politics. If someone makes a mistake they must resign, be fired and never grace our TV screens or webpages again.

Our author laments the situation on page 185, “We don’t study routine failures in teaching, in Law, in government programs, in the financial industry, or elsewhere. We don’t look for the patterns of our recurrent mistakes or devise and refine potential solutions for them.” And it’s exactly those potential solutions that we so badly need! So avoid our failures and continue to perpetuate them.

I think, in general, he’s right. We’re very aware of the failures in all those fields, as we are often aware of the failures of people within the spiritual vocations. Our problem is that we generally treat such failures only in the realms of figuring blame and enacting punishment. When I’ve tried to reflect and process on my own failures in my chosen vocation the typical response from friends and other church leaders has been one of “Well, just don’t worry about it. You’re a good guy and we know that.” Hey, I know that, too! Few, myself included, have been ready to sit and really hash into possible patterns of failure and the potential solutions to which Dr. Gawande alludes.

Conclusion: This is a good read! The author made me laugh out loud several times and consistently challenged my thinking on systems and process. I’m still working through the ways his ideas and thoughts might impact me as a professional. I’m not sure what I might end up doing with the experience of his little book, but do know that I’ll be changed by it, my work will be changed by it, and all that change will be for the better.