Atul Gawande became my hero when I read "The Cost Conundrum" in the June 2009 issue of The New Yorker. The article explores the question of why Medicare costs in McAllen, Texas, are higher than any other place in United States. Gawande, a surgeon at Brigham and Women's Hospital in Boston, went to McAllen and conducted his own investigation into the matter.
"The Cost Conundrum" is a compelling read because Gawande tells stories to illustrate his points - stories to which the average nonclinical reader, like me, can relate. (The article is available online at
Gawande's passion pulls you in. His first-hand knowledge of how medical care is delivered in the United States keeps you reading. His insight is relevant and riveting. He's ascended to my list of favorite authors. I read what he writes.
Last week, I got to the airport early enough to visit the bookstore in advance of my flight. I had several ideas in mind for my reading entertainment during the flight. But there it was in an attention-grabbing red cover with a giant white checkmark: "The Checklist Manifesto - How to Get Things Right" by Atul Gawande. I read half of the book on the outgoing flight and the remainder on the return flight. It did not disappoint. In fact, it energized me, despite the fact that I am a constant list-maker.
In "The Checklist Manifesto," Gawande does what he does best. He uses real-life experiences to show the success of a good checklist and the failure of a missing or inadequate checklist. For example, he opens the book with a story about a man who showed up in an emergency room with a two-inch stab wound in the abdomen. The surgery was anticipated to be routine, but it soon escalated into a life-or-death situation. It turned out that the injured guy was at a costume party. He encountered a soldier's bayonet that made a deceptively small entry wound but caused a path of destruction all the way up to his aorta. The medical team in attendance followed their checklist, but the checklist didn't include the step of asking the patient how he got the injury.
The beauty of Gawande's checklist is its universal application. A bonus of the checklist is its ability to foster collaboration. For example, he mentions introductions as a carefully devised step in the Johns Hopkins operating team checklist. This is because psychology studies indicate "people who don't know one another's names don't work nearly as well [together] as those who do."
Gawande's checklist manifesto might just be the most cost-effective method available for getting things done right the first time around. After all, it breaks things down to the basics, promotes common sense and fosters teamwork. And, it makes for a good read.
Contributing Editor Leanne Fosbre, CEBS, is a senior summary plan description writer with HighRoads, an HR IT consulting company headquartered in Woburn, Mass. She partners with clients' vendors and legal counsel to create accurate, user-friendly and current summary plan documents. Fosbre is a certified employee benefits specialist and an ISCEBS Fellow. She can be reached at
