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http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742 http://www.amazon.com/Checklist-Manifesto-How-Things-Right/d... This is a book on the

http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742 http://www.amazon.com/Checklist-Manifesto-How-Things-Right/d... This is a book on the topic you brought up. Doctor's have too much ego to follow a checklist. It doesn't make sense however since extremely smart people in the military and nasa follow checklists all the time.

yock 16y ago
It isn't a matter of intelligence but rather of culture. Most of what occurs in a hospital is seen as an exercise in problem solving. Applying rote knowledge and experience to a patient's current situation and making decisions about his or her care. Most of the culture highly values memorization as well. It is seen as a demonstration of proficiency. There is some legitimacy to this, as demonstrating the ability to memorize a procedure that is not time-critical often indicates an ability to memorize those that are. Consider an arresting patient who desperately needs venus access for life-saving medication. Consulting a checklist in such a situation means seconds lost, and seconds often make huge differences in survivability. It just isn't as simple as looking at other industries and seeing success, then applying it to another industry expecting similar outcomes. The people, procedures, environments, and attitudes are all vastly different.
- adamilardi 16y ago
  I think you're confusing the split second decision making required during a surgical emergency and the simple steps they need to take before starting to prevent infection and common issues. Such as making sure everyone washed their hands, correct dressings are used, having the right medication available for the procedure etc. It should be don't start this procedure until all the checks are ticked. Just like a pilot doesn't take off before he's done with his checklist. Personally I'd rather my surgeon go through a checklist of 20 things before operating on me than trying to remember them.
  - yock 16y ago
    I think perhaps I wasn't clear. I don't disagree that checklists aren't a great tool in an environment less sensitive to time constraints, rather, I believe that the culture of the healthcare industry is one of constantly being prepared for time constraints. Healthcare professionals tend to apply the same procedures in both critical and non-critical circumstances, and I think there is some legitimacy to that Imagine the nurse who spends her entire shift insertting IVs. Now imagine that she grows accustomed to working off a checklist everytime. Day in and day out she operates with a checklist for weeks and months on-end. Suddenly, a patient goes critical on her shift and she has seconds to insert a life-saving IV for fluids and medication. Can she operate efficiently without a checklist? I suspect the answer to that question is a resounding "no" and that her patient's life suffers as a result. The situation isn't as cut and dry as I'm making it, that's for sure. No doubt there is incompetency and complacency all throughout the industry, and checklists could probably combat that effectively. I just think that mandating their use across the board in every circumstance will have unintended consequences that may very well cost lives.
    - adamilardi 16y ago
      So far the research has shown that it does save more lives than it would hurt. " Suddenly, a patient goes critical on her shift and she has seconds to insert a life-saving IV for fluids and medication. Can she operate efficiently without a checklist? I suspect the answer to that question is a resounding "no" and that her patient's life suffers as a result." The point of the checklist is not to replace knowledge it's to prevent stupid mistakes. The nurse should know how to do these things without the checklist. The only reason it's there is to prevent laziness and forgetfulness. It's easy to forget one step out of x when you do it all day. I'd even say the checklist would make him/her better in an emergency because they are conditioned to do the same thing over and over. Like a ninja master!

yock 16y ago

It isn't a matter of intelligence but rather of culture. Most of what occurs in a hospital is seen as an exercise in problem solving. Applying rote knowledge and experience to a patient's current situation and making decisions about his or her care. Most of the culture highly values memorization as well. It is seen as a demonstration of proficiency. There is some legitimacy to this, as demonstrating the ability to memorize a procedure that is not time-critical often indicates an ability to memorize those that are. Consider an arresting patient who desperately needs venus access for life-saving medication. Consulting a checklist in such a situation means seconds lost, and seconds often make huge differences in survivability. It just isn't as simple as looking at other industries and seeing success, then applying it to another industry expecting similar outcomes. The people, procedures, environments, and attitudes are all vastly different.

adamilardi 16y ago
I think you're confusing the split second decision making required during a surgical emergency and the simple steps they need to take before starting to prevent infection and common issues. Such as making sure everyone washed their hands, correct dressings are used, having the right medication available for the procedure etc. It should be don't start this procedure until all the checks are ticked. Just like a pilot doesn't take off before he's done with his checklist. Personally I'd rather my surgeon go through a checklist of 20 things before operating on me than trying to remember them.
- yock 16y ago
  I think perhaps I wasn't clear. I don't disagree that checklists aren't a great tool in an environment less sensitive to time constraints, rather, I believe that the culture of the healthcare industry is one of constantly being prepared for time constraints. Healthcare professionals tend to apply the same procedures in both critical and non-critical circumstances, and I think there is some legitimacy to that Imagine the nurse who spends her entire shift insertting IVs. Now imagine that she grows accustomed to working off a checklist everytime. Day in and day out she operates with a checklist for weeks and months on-end. Suddenly, a patient goes critical on her shift and she has seconds to insert a life-saving IV for fluids and medication. Can she operate efficiently without a checklist? I suspect the answer to that question is a resounding "no" and that her patient's life suffers as a result. The situation isn't as cut and dry as I'm making it, that's for sure. No doubt there is incompetency and complacency all throughout the industry, and checklists could probably combat that effectively. I just think that mandating their use across the board in every circumstance will have unintended consequences that may very well cost lives.
  - adamilardi 16y ago
    So far the research has shown that it does save more lives than it would hurt. " Suddenly, a patient goes critical on her shift and she has seconds to insert a life-saving IV for fluids and medication. Can she operate efficiently without a checklist? I suspect the answer to that question is a resounding "no" and that her patient's life suffers as a result." The point of the checklist is not to replace knowledge it's to prevent stupid mistakes. The nurse should know how to do these things without the checklist. The only reason it's there is to prevent laziness and forgetfulness. It's easy to forget one step out of x when you do it all day. I'd even say the checklist would make him/her better in an emergency because they are conditioned to do the same thing over and over. Like a ninja master!