The Checklist Manifesto_ How to Get Things Right - Atul Gawande [34]
“Fire mushrooms. Fire mozz. Lobo on hold. Steak very well done, no gluten, on hold.”
“Fire” meant cook it now. “On hold” meant it was a second course. “Lobo” was the lobster. The steak needed to be cooked all the way through and the customer had a gluten allergy. A read-back was expected to confirm that the line cooks had heard the order right.
“Fire mushrooms. Fire mozz,” said one.
“Lobo on hold,” said the seafood cook.
“Steak very well done, no gluten, on hold,” said the grill chef.
As in the construction world, however, not everything could be anticipated and reduced to a recipe. And so Adams, too, had developed a communication checklist to ensure people recognized, and dealt with, unexpected problems as a team. At five o’clock, half an hour before opening, the staff holds what she calls the “pow wow.” Everyone gathers in the kitchen for a quick check to discuss unanticipated issues and concerns—the unpredictable. The night I was there, they reviewed the reservation count, two menu changes, how to fill in for a sick staff member, and a sweet sixteen party with twenty girls who were delayed and going to arrive in the midst of the dinner rush. Everyone was given a chance to speak, and they made plans for what to do.
Of course, this still couldn’t guarantee everything would go right. There remained plenty of sources of uncertainty and imperfection: a soup might be plated too early and allowed to cool, a quail might have too little sauce, a striped bass might come off the grill too dry. So Adams had one final check in place. Every plate had to be reviewed by either her or the sous chef before it left the kitchen for the dining room. They made sure the food looked the way it should, checked it against the order ticket, gave it a sniff or, with a clean spoon, maybe even a taste.
I counted the dishes as they went by. At least 5 percent were sent back. “This calamari has to be fried more,” the sous chef told the fry cook. “We want more of a golden brown.”
Later, I got to try some of the results. I had the fried olives, the grilled clams, the summer succotash, and a local farm green salad. I also had the lobster. The food was incredible. I left at midnight with my stomach full and my brain racing. Even here, in one of our most particularized and craft-driven enterprises—in a way, Adams’s cooking is more art than science—checklists were required. Everywhere I looked, the evidence seemed to point to the same conclusion. There seemed no field or profession where checklists might not help. And that might even include my own.
5. THE FIRST TRY
In late 2006, a woman with a British accent and a Geneva telephone number called me. She said that she was from the World Health Organization and she wanted to see whether I might help them organize a group of people to solve a small problem. Officials were picking up indications that the volume of surgery was increasing worldwide and that a significant portion of the care was so unsafe as to be a public danger. So they wanted to develop a global program to reduce avoidable deaths and harm from surgery.
I believe my response was, “Um, how do you do that?”
“We’ll have a meeting,” she said.
I asked how much money they’d be devoting to the problem.
“Oh, there’s no real money,” she said.
I said no. I couldn’t do it. I was busy.
But she knew what she was about. She said something along the lines of, “Oh, sorry. I thought you were supposed to be some kind of expert on patient safety in surgery. My mistake.”
I agreed to help organize the meeting.
One of the benefits of joining up to work with WHO was gaining access to the health system reports and data from the organization