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We have unraveled a staggering number of the body's secrets: to attack some 13,000 diagnoses, doctors now wield an arsenal of 6,000 drugs and 4,000 procedures. But surgeon and author Atul Gawande says the very vastness of our knowledge gets in the way: doctors make errors because they simply can't remember it all. The solution, he outlines in his new book, The Checklist Manifesto: How to Get Things Right, isn't fancier technology or more training. It's as simple as an old-fashioned checklist, like those used by pilots, restaurateurs and construction engineers. When his research team introduced one in eight hospitals in 2008, major surgery complications dropped 36% and deaths plunged 47%. Gawande talked to TIME about why checklists work, what's wrong with medical school and what's next for health care reform.

You write that we're often reluctant to believe that something as banal-sounding as a checklist can get results and look for heroes — as we did in the "Miracle on the Hudson," for instance.
We didn't want to believe that Sully [Captain Chesley Sullenberger] had computer systems helping guide the plane down or that his co-pilot was playing a crucial role. When I do an operation, it's half a dozen people. When it goes beautifully, it's like a symphony, with everybody playing their part. And then I go talk to the family and they say, 'Thank you, doctor, for saving my husband.' You feel a little bit like a fraud. One thing that has struck me is that we are building medicine as a series of pieces. It's like building a car without understanding it's a system. We concentrate on getting the very best people and the best technologies, in the same way you might put a car together by saying, Hey, let's takes the brakes of a Ferrari and the chassis of a BMW and the body of a Volvo. When you put it together, you just get a pile of junk that's very expensive and doesn't work very well.

You say checklists can help fix that but sometimes run against the medical culture.
We evolved from a world where the operating theater — we called it a theater — was a stage for the surgeon. Now it is a stage for an entire team of people to work in sync. The most important component [of the checklist] has turned out to be making sure that everybody in the room has been introduced by name and that people just take a minute to discuss the case in advance. I introduced the checklist in my operating room, and I've not gotten through a week without it catching a problem. It has been really eye-opening. You just realize how fundamentally fallible we are.

How can medical schools encourage doctors to be more willing to talk about failure?
We don't equip people who are about to be doctors for the idea that they're going to fail and that they have a responsibility to build a plan for that understanding. We don't prepare people for the idea that you really work in teams nowadays. [In medical school] you learn the physiology of the body. And then you learn the diagnoses and the treatments. You could get all of those first steps right and your patient will still die. Because you weren't able to get the radiologist and the nurse and the rest of your team working in sync. Who's going to teach that? We don't have the senior medical people who really understand how to do this.

Your focus is on checklists in surgery. Can checklists help a doctor working alone?
I had a patient just the week before Christmas who had a tumor found in his abdomen. It was on multiple spinal X-rays he'd had, but they were just looking at the spine and they forgot to check the other images. It's a kind of basic mistake radiologists can make. But if you have a checklist, you make sure you've looked.

You mention that some doctors object on the grounds that checklists take too long. Do they?
If they're badly designed. One of the fascinating things to me was going to visit Boeing's checklist factory, where they make over 100 checklists a year and design them in ways that pilots can actually use them in a time crush. They helped us design ours. We set a target that no step along the way would take more than 60 seconds and the whole process should be, in routine situations, under two minutes total. The Mayo Clinic adopted the checklist that we designed. And they actually reduced their operating time, because it helped the teams be more prepared.

Do you think most doctors would expect that?
No. A lot of the reaction is, 'My God, another piece of paperwork? It's just a waste of time.' We had 20% in our surveys [of doctors who adopted the checklist in a study] that still felt it was a pain, a waste of time; they didn't want to use it. Of course, we asked them a follow-up question: If they were having an operation, would they want the checklist? And 94% of them did.

Let's talk about health care reform. Do you think the Democrats have gotten it basically right or wrong when it comes to slowing the growth of medical spending?
The core point at which health care costs explode is the point at which the doctor and the patient sit down together to make a decision about what they should do for care. We have not concentrated enough, in our thinking about reform, on that moment. What we want is care that is much better organized. We are going to need approaches like checklists to get rid of wasted care and to make sure we're taking the right steps forward. [The health care reform bills] don't have the answers. There was no bill that was going to have the answers. [But] I think the components are there.

• Laura Fitzpatrick
• Surgeon and best-selling author Atul Gawande talks to TIME about how something as simple as a checklist can prevent medical errors