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Unfortunately the push for checklists has been made more for the purposes of decreasing physician autonomy and increasing reliance on mid-level practitioners as

Unfortunately the push for checklists has been made more for the purposes of decreasing physician autonomy and increasing reliance on mid-level practitioners as a "cost saving" tool. The big difference between aviation and medicine is that human patients are more complex and variable than machines like airplanes. Sure checklists can improve some things, but they're not the definitive fix for anything. In fact, checklists can actually slow down decision making unnecessarily, especially in situations when seconds matter.

NikolaeVarius 8y ago
The fact that things are complex is the exact reason checklists exist. It forces you to go through steps and actually verify things that are easily preventable. https://www.npr.org/templates/story/story.php?storyId=122226184 https://www.npr.org/templates/story/story.php?storyId=122226... "How did surgeons respond to the suggestion that they should change the way they operate? Says Gawande, many were resistant at first. "You can imagine the response" to the idea of running through a checklist before surgery, Gawande says. But when his team surveyed the doctors who used the checklist, "There was about 80 percent who thought that this was something they wanted to continue to use. But 20 percent remained strongly against it. They said, 'This is a waste of my time, I don't think it makes any difference.' And then we asked them, 'If you were to have an operation, would you want the checklist?' Ninety-four percent wanted the checklist.""
- philwelch 8y ago
  Checklists are great for not forgetting about things, and forgetting about things is a common source of human error (oh man, I forgot to run unit tests/recover those foreceps from the abdominal cavity/etc). It’s not sufficient, because sometimes you have to make judgment calls and creative decisions, but even then, I’d rather be free to think about that stuff without having the back of my mind worrying about some fiddly steps I may forget.
  - NikolaeVarius 8y ago
    It's isn't just about not forgetting about things, it's also about PROVING that you're actively doing what should be doing. The point of checklists is to massively reduce the chances that you ever have to make a "creative" decision. Thinking that checklists is a waste of time is what lets things like leaving tools inside a patient happen.
someguydave 8y ago
Aviation is simpler than medicine, usually there's a "correct answer" for solving any given problem with a particular aircraft and situation. With medicine, every patient is different and most treatments work only with a certain likelihood.
- krapht 8y ago
  I think you're overestimating the complexity of your average medical problem :). Medical situations that require Dr. House are the exception, not the rule.
jay-anderson 8y ago
My understanding of checklists in this context is they are not intended to decrease autonomy. They aren't meant as a means to use lower skilled labor for important tasks. Instead they make sure the baselines are taken care of and we aren't skipping important steps in specific and possibly stressful situations. That said I'm sure some people will have a negative view checklists and some implementors will want to misuse and implement them in the wrong way.
- lliamander 8y ago
  In this context, you are correct. There are contexts where checklists are used where the workers are low-skilled and lack autonomy (e.g. low-level customer support roles). I think many people rankle at the idea of their job consisting entirely of checking off items in a list (other people seem to be fine with it).

NikolaeVarius 8y ago

The fact that things are complex is the exact reason checklists exist. It forces you to go through steps and actually verify things that are easily preventable. https://www.npr.org/templates/story/story.php?storyId=122226184 https://www.npr.org/templates/story/story.php?storyId=122226... "How did surgeons respond to the suggestion that they should change the way they operate? Says Gawande, many were resistant at first. "You can imagine the response" to the idea of running through a checklist before surgery, Gawande says. But when his team surveyed the doctors who used the checklist, "There was about 80 percent who thought that this was something they wanted to continue to use. But 20 percent remained strongly against it. They said, 'This is a waste of my time, I don't think it makes any difference.' And then we asked them, 'If you were to have an operation, would you want the checklist?' Ninety-four percent wanted the checklist.""

philwelch 8y ago
Checklists are great for not forgetting about things, and forgetting about things is a common source of human error (oh man, I forgot to run unit tests/recover those foreceps from the abdominal cavity/etc). It’s not sufficient, because sometimes you have to make judgment calls and creative decisions, but even then, I’d rather be free to think about that stuff without having the back of my mind worrying about some fiddly steps I may forget.
- NikolaeVarius 8y ago
  It's isn't just about not forgetting about things, it's also about PROVING that you're actively doing what should be doing. The point of checklists is to massively reduce the chances that you ever have to make a "creative" decision. Thinking that checklists is a waste of time is what lets things like leaving tools inside a patient happen.

someguydave 8y ago

Aviation is simpler than medicine, usually there's a "correct answer" for solving any given problem with a particular aircraft and situation. With medicine, every patient is different and most treatments work only with a certain likelihood.

krapht 8y ago
I think you're overestimating the complexity of your average medical problem :). Medical situations that require Dr. House are the exception, not the rule.

jay-anderson 8y ago

My understanding of checklists in this context is they are not intended to decrease autonomy. They aren't meant as a means to use lower skilled labor for important tasks. Instead they make sure the baselines are taken care of and we aren't skipping important steps in specific and possibly stressful situations. That said I'm sure some people will have a negative view checklists and some implementors will want to misuse and implement them in the wrong way.

lliamander 8y ago
In this context, you are correct. There are contexts where checklists are used where the workers are low-skilled and lack autonomy (e.g. low-level customer support roles). I think many people rankle at the idea of their job consisting entirely of checking off items in a list (other people seem to be fine with it).