Throughout The Checklist Manifesto: How to Get Things Right, Atul Gawande maintains that the true purpose of a checklist is to foster communication between team members. In a surgical setting, the traditional top-down command structure inhibits effective communication, which Gawande sees as a primary culprit for easily avoidable mistakes. Speaking as a hypothetical surgeon, a “master physician,” Gawande says, “This is my patient. This is my operating room. And the way I carry out an operation is my business and my responsibility. So who do these people think they are, telling me what to do?” (159). In Gawande’s experience (albeit exaggerated), ego and vanity permeate the medical field, all of which stem from the traditional power dynamics of the operating room. He sees ego as a detriment to his profession, and something the checklist helps reduce because it decentralizes authority, spreading it to other personnel.

As Gawande conducts research on the use of checklists across different industries (aviation, construction, etc.), he discovers how these lists encourage a more democratic approach to problem-solving. He states “in a world in which success now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person’s abilities, individual autonomy hardly seems the ideal we should aim for” (183).