How a checklist can save your life

The smartest surgeons are following 'The Checklist Manifesto' and lowering the death rate at hospitals.
Written by Melanie D.G. Kaplan, Inactive

Aviators do it. Scientists do it. Even the bearded man from the North Pole does it.

The best and brightest are following checklists, and in many cases, by doing so, they’re saving lives.

That was the message from surgeon and writer Atul Gawande last night, when he talked about his new book, The Checklist Manifesto, at Washington’s Politics & Prose.

“I never thought I’d be writing a book about checklists, of all things,” said Gawande, an associate professor of surgery at Harvard Medical School, staff member of Brigham and Women’s Hospital and the Dana Farber Cancer Institute, and staff writer for The New Yorker. He said the deepest struggle in health care today is not insurance or bureaucratic hassles. It’s the increasing complexity required by jobs of health care professionals. (“It ain’t like Grey’s Anatomy,” he said.) The answer, he explains in his book, has more to do with procedure than it does pedigree.

“As experts, we will fail,” he said. “As elites, we will fail. The first thing they teach aviators, surprisingly, is, ‘You’re going to screw up. And it’s going to kill someone. Definitely you and maybe others.’”

Due to increasing complexity in our jobs, it’s easy to lose sight of critical tasks. The argument for the checklist is that experts and leaders need written guides to walk them through the steps of any complicated procedure. And if any procedure is complicated, it’s surgery--during which so many things can go wrong, from blood disasters to infections to treating the wrong side of a patient’s body or the wrong patient altogether. Two million people pick up infections in hospitals because people didn’t wash their hands. 100,000 of them die.

Today the human body is affected by 13,600 different conditions; there are 6,000 drugs and 4,000 medical/surgical procedures, according to Gawande. And for each of these diagnoses, there are steps that can help the success rate.

In his book, Gawande distinguishes between ignorance, when the knowledge doesn’t exist; and ineptitude, when the knowledge exists but an individual or group of individuals fails to apply it correctly. We have a tolerance for failure by leaders when it comes to the former, he said, but not the latter. (“What do you mean they didn’t wash their hands?”)

Following other industries, such as aviation (a pilot wouldn’t think of getting on a plane without a checklist), Gawande experimented with checklists in hospitals around the world and found, after three months and 8,000 patients, there was, on average, a 46 percent reduction in deaths.

Today, 2,000 hospitals have adopted the checklist procedures, including 20 percent of hospitals in the United States. Gawande said he has not been able to get through one week during which a checklist hasn’t caught something, and a checklist has saved the life of at least one of his patients.

For experts, using a checklist is counterintuitive. If you’ve trained for years, memorized procedures and rules and earned degrees and awards, you know what you’re doing, right? But a pesky little trait of being human is that we make mistakes, and the chances for mistakes increase as our brains go into data overload. More hospitals need to adopt the checklist manifesto and take a page from Captain Sully’s book after he landed Flight 1549 in the Hudson. Everyone wanted him to be a “hero,” but when asked, he said the successful landing was about adherence to protocol and teamwork. In other words, he and his co-pilot were simply following their checklist.

Click here to read about a checklist study by the University of Michigan.

This post was originally published on Smartplanet.com

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