![]() ![]() Just as important, it also made clear that the surgeon could not start the operation until the nurse gave the okay and removed the tent, a subtle cultural shift. This served as a reminder to run the checklist before making the incision. The metal tent was six inches long, just long enough to cover a scalpel, and the nurses were asked to set it over the scalpel when laying out the instruments before a case. He designed a little metal tent stenciled with the phrase Cleared for takeoff and arranged for it to be placed in the surgical instrument kit. ![]() They supply a set of checks to ensure the stupid but critical stuff is not overlooked, and they supply another set of checks to ensure people talk and coordinate and accept responsibility while nonetheless being left the power to manage the nuances and unpredictabilities the best they know-how. And for checklists to help achieve that balance, they have to take two almost opposing forms. The routine requires balancing a number of virtues: freedom and discipline, craft and protocol, specialized ability, and group collaboration. They had made the reliable management of complexity a routine. More remarkably, they had learned to codify that understanding into simple checklists.
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