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Atul Gawande explains in great detail how simple checklists can have big impacts. For example, why would you need everyone in the room to say their name and wh
by alexpotato 8y ago
Atul Gawande explains in great detail how simple checklists can have big impacts.
For example, why would you need everyone in the room to say their name and what they do?
Simple: everyone is wearing a mask and often surgical scrubs that are the same color. By having everyone say "Hello, my name is Dr. Jones and I'm the anaesthesiologist" you can quickly determine who is the person to direct questions to about the patient being under.
It gets even crazier when you hear stories about doctors going into the wrong operating room (especially at bigger hospitals where there are several ORs). A simple "State who you are and why you are here?" costs very little and helps avoid costly mistakes.
Another example: having a checklist allows a junior person (e.g. a nurse) to challenge more senior people when they make a mistake.
Example without checklist:
Nurse: Dr, I think you forgot to do X.
Dr: I know what I'm doing, don't question me.
Example WITH checklist:
Nurse: Dr, you missed step #4.
Dr: I'm sorry, you are correct. We all agreed that was a necessary step and I missed it.
As have others in sibling threads, highly recommend Gawande's Checklist Manifesto.
- mnw21cam 8y agoA lot of airline-style cockpit resource management is being adapted for operating theatres, and it is a good thing. If a junior person thinks that a senior person is about to make a terrible mistake, then the word "Stop!" should be used, along with the reason. That word will often make even the most arrogant person pause and think about what they are doing.
- IMTDb 8y agoYour example depends more on the personality (and mood) of the surgeon than on the existence of a checklist. Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: Oh, you are right, thanks a lot Example with checklist : Nurse: Dr, you missed step #4. Dr: I have done this list every day for the past 15 years, I know I ddid not forget anything, don't question me
- alexpotato 8y agoYou are correct that there are surgeons etc that would reply in the negative no matter what was said. My understanding is that if the checklist empowers, say, 5% of the nurses to speak up and 5% of surgeons to acknowledge the error that is still a huge net positive over thousands of cases. My favorite small nudge example is pill bottles vs "blister" packs. Having pills in blister packs has shown to have a significant effect on reducing suicide as it makes it much harder to get the number of pills needed. Yes, some people will still succeed but there is a segment of the target population who will give up after a couple pills.
- mnw21cam 8y agoI have a prescription that means I take eight pills in one go. And they are provided in blister packs. It's really annoying. I can see that this is a thing.
- wwweston 8y agoNothing will stop someone who's disagreeable, assertive, non-conscientious AND given unchecked status from ignoring a step for capricious reasons. But medical school is going to heavily select for conscientiousness (a personality trait that checklists work with), and also checklists are essentially another authority in the room. So, yes, you could potentially have discussions over whether or not something has actually been done. But you aren't going to have discussions about whether it should be.
- throw0101a 8y ago> Example with checklist : Nurse: Dr, you missed step #4. Dr: I have done this list every day for the past 15 years, I know I ddid not forget anything, don't question me You're not wrong, but if the hospital policy is to follow checklists, then the doctor overriding it would have to answer some questions afterwards if something were to go wrong. Presumably a review would occur, and the fact that the checklist was ignored could be used as 'evidence' against the doctor.
- rb808 8y agoThe solution to that is to have people have proper uniforms. Eg surgeons/doctors/nurses wear different color scrubs & hats or insignia for rank. It was like this in the old days.