Rules are Tools


Atul Gawande

"We are not omniscient or all-powerful. Even enhanced by technology, our physical and mental powers are limited. Much of the world and universe is -and will remain- outside our understanding and control." (p. 8)

"Substantial parts of what software designers, financial managers, firefighters, police officers, lawyers, and most certainly clinicians do are now too complex for them to carry out reliably from memory alone. Multiple fields, in other words, have become too much airplane for one person to fly." (p. 34)

"The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events." (p. 36)

"In response to risk, most authorities tend to centralize power and decision making. That’s usually what checklists are about -dictating instructions to the workers below to ensure they do things the way we want." (p. 72)

"There must always be room for judgment, but judgment aided -and even enhanced- by procedure." (p. 79)

"Pilots (...) tum to their checklists for two reasons. First, they are trained to do so. They learn from the beginning of flight school that their memory and judgment are unreliable and that lives depend on their recognizing that fact. Second, the checklists have proved their worth -they work." (p. 121)

"It runs counter to deeply held beliefs about how the truly great among us -those we aspire to be- handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating." (p. 173)

"We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at." (p. 183)

"We don’t study routine failures in teaching, in law, in government programs, in the financial industry, or elsewhere. We don’t look for the patterns of our recurrent mistakes or devise and refine potential solutions for them. But we could, and that is the ultimate point." (p. 185)

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