The Checklist Manifesto

1. Checklists are essential tools for managing complexity in high-stakes fields

We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable.

Complexity exceeds the limits of professional expertise. In sophisticated sectors such as medicine, aviation, and finance, the sheer quantity of specialized knowledge and the intricacy of required procedures can overwhelm even the most capable individuals. This environment increases the risk of errors and oversight, which can lead to significant failures. Checklists serve as a systematic mechanism to navigate this complexity, ensuring that essential steps are executed and facilitating team coordination.

• Fields where checklists mitigate complexity:
  • Surgical procedures
  • Flight operations
  • Large-scale construction
  • Financial management
  • Crisis management

The role of checklists as cognitive supports. By externalizing memory and standardizing decision-making, checklists allow professionals to dedicate their mental energy to complex problem-solving rather than routine verification. They function as a safety infrastructure that identifies and prevents basic errors often committed by experts under high-pressure or repetitive conditions.

2. Even experts can benefit from checklists to prevent simple mistakes

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.

The limitations of human expertise. High levels of training and experience do not eliminate the possibility of human error. Checklists support professional expertise by ensuring that fundamental, high-stakes steps are not missed during complex operations.

Preventing "stupid" errors. Checklists are specifically designed to counteract the psychological and physical factors that lead to mistakes, such as:

• Failures in memory
• Loss of focus or distractions
• Physical and mental exhaustion
• Professional overconfidence
• Constraints imposed by limited time

Empirical evidence of effectiveness. In the medical field, the application of basic checklists has correlated with substantial decreases in post-surgical infections and mortality. Similar results regarding safety and reliability have been documented in the aviation, construction, and investment industries when checklists are integrated into standard practice.

3. Effective checklists are concise, practical, and tested in real-world situations

Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane.

Core features of functional checklists:

• They are succinct and prioritize critical "killer items."
• They use unambiguous, straightforward terminology.
• They are designed for ease of use in actual work environments.
• They undergo constant refinement based on practical feedback.

The development of a checklist. Building a useful tool requires identifying the most vital stages of a task. This process involves collaboration with subject matter experts and multiple phases of trial and error. The objective is to support professional performance without creating unnecessary administrative burdens.

Methodological approaches. There are two primary formats:

1. READ-DO: Users execute each step immediately after reading it.
2. DO-CONFIRM: Users perform tasks from memory and subsequently use the checklist to verify completion.

The selection of a format depends on the specific operational requirements and the context of the task.

4. Checklists improve teamwork and communication in complex environments

They had determined that the most promising thing to do was just to have people stop and talk through the case together—to be ready as a team to identify and address each patient's unique, potentially critical dangers.

Enhancing interpersonal communication. Checklists provide a structured protocol for team members to share information. This ensures that every participant understands the objectives, recognizes potential hazards, and knows their specific duties.

Mitigating professional hierarchies. By mandating input from every team member, checklists help flatten rigid hierarchies that might otherwise prevent staff from reporting concerns. This is vital in settings like operating rooms, where junior personnel might feel uncomfortable challenging their superiors.

The checklist as a collaborative framework:

• It facilitates formal introductions and defines specific roles.
• It establishes mandatory pauses for team consultation.
• It helps create a unified understanding of the mission.
• It grants every team member the authority to signal a problem.

5. Resistance to checklists often stems from professional ego and autonomy concerns

We don't like checklists. They can be painstaking. They're not much fun. But I don't think the issue here is mere laziness. There's something deeper, more visceral going on when people walk away not only from saving lives but from making money.

The obstacle of professional identity. Experts frequently reject checklists because they perceive them as a challenge to their intelligence or experience. There is a common cultural assumption that mastery involves performing complex tasks without external assistance.

Balancing independence with discipline. Utilizing checklists requires a cultural transition from prioritizing individual discretion to valuing rigorous, disciplined cooperation. This shift is often difficult for professions that traditionally celebrate personal judgment as the primary driver of success.

Strategies for addressing pushback:

• Presenting empirical data and case studies that prove effectiveness.
• Engaging respected industry leaders in the creation and promotion of these tools.
• Defining checklists as aids that augment, rather than replace, professional skill.
• Promoting a culture that respects both individual talent and structured methodology.

6. Checklists have revolutionized aviation safety and can do the same for other fields

After our London meeting, we did more small-scale testing—just one case at a time. We had a team in London try the draft checklist and give us suggestions, then a team in Hong Kong. With each successive round, the checklist got better.

The aviation model. The significant increase in flight safety over recent decades is largely due to the integration of checklists. This industry serves as a primary example for other high-stakes sectors.

Applying aviation principles elsewhere. The strategies used in flight safety can be tailored to various industries by:

• Mapping out critical failure points and essential actions.
• Drafting clear and brief checklist points.
• Committing to the regular revision of procedures.
• Embedding checklists into the official workflow.
• Encouraging a professional environment focused on discipline.

Cross-industry applications. Success has been found in several areas, including:

• Healthcare (intensive care and surgery)
• Building and infrastructure (safety and project oversight)
• Investment (risk evaluation and decision-making)
• Crisis management (response protocols)

7. The modern hero embraces checklists and teamwork over individual autonomy

This was what was unusual. This is what it means to be a hero in the modern era. These are the rare qualities that we must understand are needed in the larger world.

Evolving the concept of the hero. In high-risk, complex environments, the contemporary hero is no longer the isolated genius. Instead, heroism is defined by the professional who utilizes tools and collaborative efforts to ensure the highest quality outcomes.

Traits of the modern professional:

• The humility to recognize that human memory is fallible.
• The discipline required to adhere to structured protocols.
• A dedication to refining processes and skills.
• A proactive approach to communication and team cooperation.

The necessity of cultural change. Adopting this perspective requires a departure from traditional professional values that prize autonomy above all else. It necessitates acknowledging that in the modern world, successful outcomes are usually the result of a team supported by reliable systems.

8. Checklists can significantly reduce errors and improve outcomes in various industries

The final results showed that the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after introduction of the checklist. Deaths fell 47 percent.

Quantifiable improvements. Using checklists has led to verified advancements in performance across multiple sectors:

• Surgery: Significant decreases in patient complications and mortality rates.
• Aviation: Lower accident rates and higher overall safety standards.
• Construction: Fewer structural failures and more precise project management.
• Finance: Enhanced risk mitigation and more consistent investment results.

Advantages beyond safety. In addition to preventing errors, checklists contribute to:

• Increased operational efficiency.
• Better synchronization between team members.
• Greater reliability in complex workflows.
• A baseline for measuring and improving performance.

Noteworthy examples. Key successes include the WHO Surgical Safety Checklist, protocols used by professional value investors, and standard project management lists in the construction industry.

9. Implementing checklists requires cultural change and leadership support

What experts like Dan Boorman have recognized is that the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form.

The role of leadership. For checklists to be effective, organizational leaders must actively endorse and use them. Their commitment is essential to overcoming institutional inertia and skepticism.

Stages of cultural integration:

1. Informing the workforce about the specific benefits and the logic of the checklist.
2. Including employees in the design and testing phases.
3. Offering comprehensive training on how to use the tool.
4. Tracking progress and recognizing successful outcomes.
5. Updating the checklist based on real-world usage and suggestions.

Solving adoption issues. It is important to address concerns regarding the time required to complete checklists and to demonstrate that these tools actually support professional judgment. Integrating checklists into the existing digital or physical workflow ensures they become a natural part of the job rather than an extra task.

By establishing a professional culture that prioritizes teamwork and systematic processes, organizations can utilize checklists to manage complexity and improve reliability in high-stakes environments.

Last updated: January 22, 2025