Free The Checklist Manifesto by Atul Gawande Page A

“skin” of the building had now been hung at those levels. The tall, shiny glass and steel exterior had been bolted into the concrete floors every few feet. The farther down we went, the more the layers had advanced. One team of subcontractors had put up walls inside the skin. The pipefitters had then put in water and drainage pipes. The tin knockers followed and installed the ventilation ducts. By the time we got down to the lowest floors, the masonry, electrical wiring, plumbing, and even some fixtures like staircase railings were all in place. The whole intricate process was astounding to behold.
    On the upper floors, however, I couldn’t help but notice something that didn’t look right, even to my untrained eyes. There had been rain recently and on each of the open floors large amounts of water had pooled in the same place—up against the walls of the inner concrete core. It was as if the floor were tilted inward, like a bowl. I asked Rouillard about this.
    “Yeah, the owners saw that and they weren’t too happy,” he said. He explained what he thinks had happened. The immense weight of the concrete core combined with the particular makeup of the soil underneath had probably caused the core to settle sooner than anticipated. Meanwhile, the outer steel frame had not yet been loaded with weight—there were still eighteen stories to be built upon it—and that’s why he believes the floor had begun to tip inward. Once the steel frame was loaded, he fully expected the floor to level out.
    The fascinating thing to me wasn’t his explanation. I had no idea what to make of his answer. But here was a situation that hadn’t been anticipated on the construction checklist: the tilting of the upper floors. At a minimum, a water cleanup would be needed and the schedule adjusted for it. That alone could throw the builders’ tidy plans off track. Furthermore, the people involved had to somehow determine whether the tilting indicated a serious construction defect. I was curious to know how they handled this question, for there was inevitable uncertainty. How could they know that the problem was just ordinary settling, that loading the steel frame would in fact level out the floor? As Rouillard acknowledged, “variances can occur.” This was a situation of true complexity.
    Back down in the field office, I asked Finn O’Sullivan how he and his team dealt with such a circumstance. After all, skyscraperbuilders must run into thousands like it—difficulties they could never have predicted or addressed in a checklist designed in advance. The medical way of dealing with such problems—with the inevitable nuances of an individual patient case—is to leave them to the expert’s individual judgment. You give the specialist autonomy. In this instance, Rouillard was the specialist. Had the building site been a hospital ward, his personal judgment would hold sway.
    This approach has a flaw, however, O’Sullivan pointed out. Like a patient, a building involves multiple specialists—the sixteen trades. In the absence of a true Master Builder—a supreme, all-knowing expert with command of all existing knowledge—autonomy is a disaster. It produces only a cacophony of incompatible decisions and overlooked errors. You get a building that doesn’t stand up straight. This sounded to me like medicine at its worst.
    So what do you do? I asked.
    That was when O’Sullivan showed me a different piece of paper hanging in his conference room. Pinned to the left-hand wall opposite the construction schedule was another butcher-block-size sheet almost identical in form, except this one, O’Sullivan said, was called a “submittal schedule.” It was also a checklist, but it didn’t specify construction tasks; it specified
communication
tasks. For the way the project managers dealt with the unexpected and the uncertain was by making sure the experts spoke to one another—on X date regarding Y process. The experts could make their