However, although these checklists entered the nursing arena in 1960 in the guise of recording vitals, they were deemed too lowly and had not entered the medical arena. The checklist aims to protect against the fallibility of human memory, distraction under pressure and to highlight the minimum necessary steps for success. In 1935, after the prototype B17 crashed, test pilots devised a simple checklist to ensure all the ‘dumb stuff’ got done. Gawande makes the case for the humble checklist, firstly drawing from the experience of the aviation industry. This is despite the remarkable expertise and superspecialisation that exist in 21st century medicine. 3 In his extremely readable style, peppered with examples, he starts by making the case for the extreme complexity inherent in our work with ill human beings, the inexpressible success when multiple interventions work together to save a life but also the avoidable failures that are nearly missed when pivotal interventions are forgotten. In this book, Atul Gawande, renown surgeon, author of Complications 1 and Better 2 and staff writer for the New Yorker, describes in his elegant style the journey that culminates in the creation and testing of the WHO surgical safety checklist. That our surgical colleagues would embrace such an activity intrigued me and set me about investigating. She chuckled and remarked that I had experienced what has been nicknamed the ‘WHO huddle’. This proved to be a rather surreal experience and on release from my corral I consulted my wife, an obstetrician about this rather peculiar activity of self-introduction among surgeons. While awaiting the start of the procedure, we were suddenly corralled into theatre and directed by a nurse to introduce ourselves as she frenetically ticked away at a checklist. However, he had ongoing melaena and the surgeons were called in to consider a surgical approach, but were keen to ensure ongoing bleeding. A 54-year-old man had presented the day before with haematemesis and melaena and was found to have a large bleeding duodenal ulcer that my colleague had injected and clipped. My gastroenterology colleague and I had ventured into unfamiliar territory, an operating theatre to observe a gastroscopy. I came across this book after an interesting brush with a rather new, enigmatic surgical phenomenon known as the World Health Organization (WHO) surgical safety checklist.

The checklist manifesto