Samar’s Reviews > The Checklist Manifesto: How to Get Things Right > Status Update

Operations require many more than nineteen steps, of course. But like builders, we tried to encompass the simple to the complex, with several narrowly specified checks to ensure stupid stuff isn’t missed (antibiotics, allergies, the wrong patient) and a few communication checks to ensure people work as a team to recognize the many other potential traps and subtleties.

. All the examples, I noticed, had a few attributes in common: They involved simple interventions— a vaccine, the removal of a pump handle. The effects were carefully measured. And the interventions proved to have widely transmissible benefits— what business types would term a large ROI (return on investment) or what Archimedes would have called, merely, leverage.

By 2004, surgeons were performing some 230 million major operations annually— one for every twenty-five human beings on the planet— and the numbers have likely continued to increase since then. The volume of surgery had grown so swiftly that, without anyone’s quite realizing, it has come to exceed global totals for childbirth— only with a death rate ten to one hundred times higher. Although most of the time a given p