It's Not the How or the What but the Who

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The Checklist Manifesto, Revisited

Before 1953, there was no standard procedure to determine if a newborn baby was in distress. The physicians in the room simply used their intuitive judgment, which unfortunately meant that danger signs were often missed, and many infants died. One day over breakfast, someone asked anesthesiologist Virginia Apgar how she might make these assessments more systematic. “That’s easy,” she replied. She jotted down five variables (heart rate, respiration, reflex, muscle tone, and color) and three scores (0, 1, 2). Babies would be rated one minute after they were born and their scores added up. Out of a maximum score of 10, 8 would mean a pink, crying, squirming, grimacing infant with a high pulse; 4 or less would ...