"The Checklist Manifesto" by Atul Gawande

Gawande is a surgeon whose failures led him to devise an aeroplane-pilot-style checklist approach to operations. He claims that this reduces failure and complications hugely and significantly.

He suggests that "Know-how and sophistication have increased remarkably across almost all our realms of endeavor, and as a result so has our struggle to deliver on them." (p11) This is because the systems delivering have become too complex for individuals to master. This causes deep customer dissatisfaction. "Failures of ignorance we can forgive. .... But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated." (p 11) This is the point at which failure becomes negligence.

His examples are mostly from surgery. Most operations involve a team of people, often including newcomers, attempting to apply standard procedures to a very individual patient. In the barely controlled chaos of an operation obvious steps are sometimes missed. Furthermore, the team is often handicapped by a lack of communication or by hierarchy and subservience preventing people from over-ruling the god-like surgeon. Gawande believes that checklists have two functions: firstly they prevent obvious steps being missed (he says that since using checklists he has not spend a single week without discovering that a step was about to be missed in his own operating theatre) and secondly they increase team spirit and help to flatten the hierarchy.

He claims that the classic hospital checklist is the four 'vital signs' (temperature, pulse rate, blood pressure and respiratory rate) chart which was introduced by nurses not doctors in  the 1960s.

Builders have used checklists since buildings became too complicated for a single 'Master Builder' to construct. Builders use two sorts of checklists: one for which jobs have been done and one for ensuring that everyone who needs to be informed has been informed.

His checklist rules.

• Every item on a checklist must be non-ambiguous.
• Some checklists are proactive and should be read out before performance, others are retroactive and should be a check after performance.
• One's procedure needs to incorporate one or more 'pause points'. Each pause point contains a single checklist.
• Checklists should be physical; ideally the whole team should agree that each item can be checked.
• Each checklist should take no more than sixty seconds.

When Gawande was designing a surgical checklist he took a lot of time to reduce the list to the barest bones (sorry about the pun!). He deliberately left out complicated items (because they might be ambiguous) and he only included items that had leverage. Operating theatre fires kill many fewer patients than post-operative infections so the checklist focuses on antibiotics rather than asbestos. This keeps the list short enough that surgeons will use it even in high pressure situations.

He emphasises that checklists help communication and team working.

He also points out that there has been significant resistance to introducing checklists into surgery despite the remarkable success rates of the WHO research that he worked on. Human beings (and perhaps especially prima donna surgeons) don't like discipline.

I would add that his checklists typically operate in situations where the system is complex but each part can be broken down into simple steps. Can they be equally successfully in the arcane mystery that is persuading pupils to learn?

Like many American books his message is very small; I think I have encapsulated it above. He spins it into a (short) book by telling stories and adding lots of detail in the stories and lots of statistics. Nevertheless, this is an enjoyable and thought-provoking read.

December 2011; 193 pages

"The Greatest Traitor" by Ian Mortimer

This life of Roger Mortimer, deposer of Edward II, is a cracking good read.

Mortimer as a young man enjoyed the company of young Prince Edward and his mates, including Piers Gaveston, at the court of Edward I. But when Ed I died and the Prince became King things began to turn sour. Ed II was besotted with Gaveston, flirting with him whilst marrying his Queen, Isabella, beautiful blonde daughter of handsome King Philip 'the Fair' of France. Gaveston became greedy and arrogant, mocking the royal Earls and stealing castles, manors and estates. Finally the noblemen got so pissed off they kidnapped and murdered him. In all this Roger supported the King.

Then it all started again but with a bloke called Hugh Despenser who was Roger's sworn enemy because Roger's grandad had killed Hugh's grandad at the battle of Evesham when Hugh's grandad had been fighting with Simon De Montfort. These families were like warring Mafia clans! But King Ed II favoured Hugh and Hugh got greedy and stole loads of land and then the Parliament insisted Hugh was exiled which he was for a while (becoming a pirate) but then he came back and got even more too big for his boots and Roger opposed him which led to Roger being done for treason and thrown into the Tower. Roger's whole family suffered, his sister-in-law being locked up in Chicksands Priory.

Roger then became one of the very few people ever to escape from the Tower. He fled to France where he got together with Isabella (on a visit to her brother who was now King) and they had an affair. They came back together and there was a rebellion and they arrested King Ed II and forced him to abdicate in favour of his son who became King Ed III. But the real power behind the throne was Roger and his mistress Queen Isabella. There was some truculence among the Lords which led to the Earl of Lancaster surrendering at Bedford and the Earl of Kent being executed for treason despite being the new King's uncle for the crime of trying to rescue his brother Ed II from Corfe Castle (even though Ed II had supposedly died at Berkely Castle).

Finally a group of men went through a secret passage into Nottingham Castle with the assistance of Ed III and arrested Roger who was hanged naked at Tyburn.

English History: better than fiction.

December 2011; 264 pages

"The Prague Golem": Vitalis 2004

I bought the book of Jewish fairy stories in Prague; it is an English translation. It is a little like the Brothers Grimm meet Orthodox Judaism. There are stories of men who discover Gold and Rabbis who cheat death. In particular the stories focus on one Rabbi, Rabbi Loew, who creates the Golem, a man fashioned from  clay and brought to life. The purpose of the Golem is to protect the Jewish community but he never seems to be used for this and shortly afterwards the Rabbi, by saying the original prayers backwards, returns the Golem to clay.

The trouble with these sort of religious stories is that morality is repeatedly confused. In Rabbi Loew the Benefactor of the Jews in Prague the good Rabbi persuades Emperor Rudolph  that "the whole community should never in future be held responsible for the guilt of the individual." This is clearly right and proper and a bedrock of decent law. In the story after next, Beleles Street, the very same Rabbi discovers that the cause of the plague which has been killing the children of the community is that two couples are wife-swapping. It is apparently OK for God, or Death, to make the whole community suffer for the sins of a few but it is not OK if the Emperor does it.

Double standards. Superstitious nonsense.

December 2011; 63 pages

"Teacher Man" by Frank McCourt

This is the third volume in Frank McCourt autobiography and follows the award winning Angela's Ashes and 'Tis. It tells the tale of McCourt becoming a teacher in New York and later a writer.

He misquotes Pope: "Know thyself, presume not God to scan/ The proper study of mankind is man" (Pope's version is Know then thyself ...).

He is very eloquent about teaching in his usual rhythmic 'I am Irish' style. There are moments which are funny and moments which are interesting but I didn't catch my breath until McCourt the teacher is interrogating a rich kid in his creative writing class about his dinner. He asks who cooked it. The maid. And served it. He asks about the table - mahogany - and the chandelier and the music. Not Mozart. Telemann. "He's one of my father's favourites," says the student. And where is your father? Then comes the brutal pay-off line: "He's in Sloan-Kettering Hospital with lung cancer and my mother is with him all he time because he's expected to die."

Instantly the world of privilege of the spoilt little rich kid dissolves into a world of despair and a little kid.

Every teacher has had a moment like that. Mine was when I asked, rhetorically, what Sabir's mother would say if she found out what he had done to be told, through tears, that his mother wouldn't say a word because her windpipe had been crushed in a car accident and it was still uncertain whether she would survive. I put my arm around Sabir and hugged him till the tears subsided.

Although at the start of the book I thought it was McCourt churning out the old Irish brogue formula that powered his previous two books (but Angela's Ashes rather more than 'Tis), when he started describing his Creative Writing classes at Stuyvesant High and the unusual (bizarre!) strategies he adopted (eg getting the students to sing recipes) his love of teaching and his characterisation of the kids he taught caught me and held me in a magical enchantment. By the end I loved the book.

December 2011; 258 pages

Other memoirs reviewed in this blog can be found here.

This review was written by the author of Bally and Bro, Motherdarling  and The Kids of God

Irish fiction reviewed in this blog:

• Strumpet City by James Plunkett: a book about the poor in Dublin in the early 20th Century
• Teacher Man by Frank McCourt: the sequel to Angela's Ashes: an Irish exile in New York
• Dubliners by James Joyce: the classic short stories
• Castle Rackrent by Maria Edgworth: a classic first published in 1800
• Paddy Clarke Ha Ha Ha by Roddy Doyle: a boy grows up in Ireland
• The Spinning Heart by Donal Ryan: set in the recession of the early 21st Century

"After the Quake" by Haruki Murakami

This is a collection of short stories by the lyrical Japanese writer.

After the Kobe earthquake Komura's wife leaves him. He flies to Hokkaido carrying a small wooden box that a colleague has given him. He is empty inside.

After the Kobe earthquake Junko watches Mr Miyake build a bonfire on a midnight beach. They decide that when the bonfire goes out they will die together.

After the Kobe earthquake Yoshiya follows the man with the missing ear to a deserted baseball stadium. He believes the man to be is father although his mother insists he is the child of God. The man with the missing ear disappears and Yoshiya dances at night in the empty stadium.

After the Kobe earthquake Satsuki,a menopausal thyroidologist, goes on holiday in Thailand. Her driver, who claims to be half dead, takes her to a fortune teller. Satsuki hates her ex-husband, hoping he was swallowed up by Kobe's liquefied earth, and mourns the children she never had.

After the Kobe earthquake a giant Frog comes to call on bank debt-collector Mr Katagiri to enlist his help in a subterranean battle to the death with Worm who is planning to destroy Tokyo with an earthquake. Katagiri may or may not get shot and wakes up in hospital.

After the Kobe earthquake Junpei tells stories about bears and honey to Sala who is scared of The Earthquake Man. Later he makes love to Sala's mum, his best friend since college, who went off with his other best friend at college.

Six stories told in Murakami's bald prose. The dialogue is stark and people often say things which have no bearing on what was said before. The characters are outlined with the efficiency of a cartoonist; there is no attempt at the multi-layering of an oil painting. They are all empty, nihilistic, hollow. The situations are all ordinary with a hint of extra-ordinary. It works at the level of fairy tales and this must be because Murakami's words, while flat, have a lyrical magic. These are haiku stories.

But while haikus often reveal beauty, these stories chronicle the dark, materialistic, violent soulessness of Japanese society.

Strange and powerful.

Dec 2011; 132 pages

"50 Literature Ideas you really need to know" by John Sutherland

I think I expected this book to be more about creative writing than it was. It started well with Mimesis (which just means imitation ie writing that tries to mirror reality) but very quickly it got into the world of literary criticism. What is a classic? Does a text belong to the writer or the reader and where does the meaning reside? Deconstruction means that every text is inherently indeterminate of meaning. Where does plagiarim begin and hommage end; where does this leave fanfic and the e-book? These topics might be fascinating to an academic but most of them came nowhere near my conception of the 50 Literature ideas I wanted let alone needed to know.

Disappointing.

December 2011; 203 pages

"The Invention of Air" by Steven Johnson

This is the biography of Joseph Priestley, Unitarian minister and Chemist. In his early days he was the author of a best-selling history of Electricity (a friend of Franklin). Later he invented soda water' He discovered that plants produce the air that flames and animals need to stay alive (but he never really discovered Oxygen, leaving that to the more careful Science of his friend Lavoisier). He was sponsored by the Lunar Society. He then wrote a controversial book debunking Christianity (he was one of the inventors of Unitarianism, denying the Trinity and the divinity of Christ). This and his radical political views at the time meant that the Birmingham mob burned his chapel and his house down and he had to go into hiding. He then emigrated to the newly independent USA. He was a great mate of 2nd President John Adams until his belief in the Book of Revelation got in the way. Later, unable to resist meddling in politics, he fell foul of the newly enacted Alien and Sedition Laws but President Adams kept him out of jail. He was quite a mate of third president Jefferson.

In other words he was a political hothead who could not restrain himself and an amateur scientist whose haphazard methods (and unwavering belief in phlogiston) made him unable to make real progress in his science.

Along the way this book muses on the Philosophy of Science. It does not really believe in the Great Man theory of history. Rather, it believes that what it calls a 'hot hand' is just a lucky streak: "a fantasy of misinterpreted probability" (p43). This fits in with the ideas suggested by eg Nate Silver in The signal and the noise and Daniel Kahneman in Thinking, fast and slow.

He also muses on the coincidence that Priestley's discovery of the interdependence of plant life and animal life came as a result of the leisure time he had due to the industrial revolution based on coal from the carboniferous era when plants evolved lignin and decomposers took some millions of years to learn how to rot lignin so it got buried and metamorphosed into coal. We tend to think of money encouraging innovation because it functions as an incentive  ... but accumulated wealth ... allowed people like Joseph Priestley to pursue scientific breakthroughs without the promise of financial reward." (p129)

A delightful book although it tends to show what a shallow scientist Priestley was and ekes this out by an American-centric account of his relationship with Americans Franklin, Adams and Jefferson.

December 2011; 240 pages

"Fifty Management ideas you really need to know" by Edward Russell-Walling

This is full of lots of interesting ideas although the concept of management seems to be restricted to commercial, preferably industrial, companies. From time to time I got a really good idea from it, rarely a paradigm-breaking idea, occasionally an idea I could directly use. But it was fun.

December 2011; 203 pages

"The Moon and Sixpence" by Somerset Maugham

Paul Gauguin, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

This delightful book is the fictionalised story of Paul Gauguin. The narrator, a writer, meets Mrs Strickland and, through her, Strickland, a stockbroker, who shortly abandons his wife, his family and his career to travel to Paris to become a painter. The wife persuades the narrator to go to Paris to persuade her husband to return but Strickland is rude and obsessive. If one is a genius one submits to the tyranny of one's art and normal human relations go out of the window. Later the narrator returns to Paris. Another 'chocolate box' artist, Stroeve is the only person who recognises the genius in Strickland but Strickland treats Stroeve like dirt, mocking him and his work. After Stroeve and his wife nurse back to life a seriously ill Strickland, Strickland seduces her and she leaves her husband. Later Strickland abandons her and she commits suicide, leaving 'ridiculous' Stroeve doubly betrayed. In the last part of the novel the narrator happens to be in Tahiti. Strickland went there, painted, and died a terrible death which the narrator pieces together with witness statements from the people who knew him.

What makes this a great book is the elegance of the prose (suggesting that the narrator is a prissy non-entity) coupled with the brutality of the ideas (standing for the rawness of art; Strickland is a man possessed by the terrible demon of art and at the same time a sensuous and brutal man loved by women). Perhaps this duality reflects Gauguin's art: simplistic and naive but full of power. The characterisations are all remarkable:

• Mrs Strickland is a women who seeks the company of artists and writers while never suspecting that her dull stockbroking husband has artistic genius; after being abandoned she opens a typing agency but after Strickland's death and subsequent fame she begins to bask again in the attention given to her as his wife.
• Dirk Stroeve the fat untalented but commercially successful artist who was ridiculous in his devotion to his wife and ridiculous again in his grief; but he was the first man who recognised the genius in Strickland.
• Mrs Stroeve who was afraid of Strickland and then left her husband for him and then killed herself when Strickland left her.
• The Tahitians: the jovial obese hotel owner with a wonderfully relaxed attitude to sex even though she was now too fat to have any; the Captain who knew Strickland in Marseilles although he was probably making his story up to please the narrator who paid for it in whisky and cigars; the doctor who attended Strickland in his last days.

Wonderful characters.

And the book is remarkable for the amount of sex in it. It was published in 1919 and it is so frank. Tahitian 17 year old Ata has "never been promiscuous like some of these girls - a captain or a first mate, yes, but she's never been touched by a native." p182 Frank and funny. And the narrator himself suggests that when sex it over "you feel so extraordinarily pure. You feel like a disembodied spirit, immaterial, and you seem to be able to touch beauty as though it were a palpable thing, and you feel an intimate communion with the breeze, and with the trees breaking into leaf, and with the iridescence of the river. You feel like God." p78

There were so many gems and bon mots in this book:

• "Only the poet or the saint can water an asphalt pavement in the confident anticipation that lilies will reward his labour." p46
• Conscience is "the policeman in all our hearts, set there to watch that we do not break its laws." p51
• "I have always been a little disconcerted by the passion women have for behaving beautifully at the death-bed of those they love. Sometimes it seems as if they grudge the longevity which postpones their chance of an effective scene." p56
• "Le Maitre de la Boite a Chocolats" [Stroeve] p62
• "Because women can do nothing except love, they've given it a ridiculous importance. They want to persuade us that it's the whole of life. It's an insignificant part. I know lust. That's normal and healthy. Love is a disease." p140
• "Here lies the unreality of fiction. For in men, as a rule, love is but an episode which takes its place among the other affairs of the day, and the emphasis laid on it in novels gives it an importance which is untrue to life. There are few men to whom it is the most important thing in the world, and they are not very interesting ones." p152
• "The sadness which you may see in the jester's eyes when a merry company is laughing at his sallies and his jokes are gayer because in the communion of laughter he finds himself more intolerably alone." p157
• "Neither wit nor whisky could detain him then." p161

The ending is equally brilliant. The narrator meets Mrs Strickland and her now grown up children (a soldier and a soldier's wife; perfectly conformist members of society with no genius) and the son quotes 'The mills of God grind slowly, but they grind exceeding small.' The narrator feels "sure that they thought the quotation was from Holy Writ" and when he contrasts this boy with Strickland's Tahitian bastard "a quotation from the Bible came to my lips, but I held my tongue, for I know that clergymen think it a little blasphemous when the laity poach upon their preserves. My Uncle Henry, for twenty-seven years Vicar of Whitstable, was on these occasions in the habit of saying that the devil could always quote scripture to his purpose. He remembered the days when you could get thirteen Royal Natives for a shilling."

This ending combines obscurity and scholarship (the Mills of God quotation is actually Longfellow but Maugham doesn't tell us that) and then teases again by offering a Biblical quotation but we are never told which. It then falls from fiction into fact: Maugham's Uncle was really the Vicar of Whitstable. It ends with another little character vignette which Maugham has peppered throughout the novel. This character, like a few of the others, has absolutely no part to play in the story. Uncle Henry is utterly incidental and yet he finished the book. Royal Natives are Whitstable oysters.

Apparently it is called The Moon and Sixpence because you can stare at the Moon whilst ignoring the sixpence at your feet.

A beautiful brilliant book.

December 2011; 215 pages

Also read: 

• Maugham's much weightier but brilliant On Human Bondage
• Maugham's spy novel Ashenden

This review was written by the author of Bally and Bro, Motherdarling  and The Kids of God