4 ms·

I have been a flight test and rocket test engineer. Checklists were life, especially in the rocket world. The fantastic thing about checklists is that they both

I have been a flight test and rocket test engineer. Checklists were life, especially in the rocket world. The fantastic thing about checklists is that they both keep you accountable and free your mental resources so that when something happens that one of your checklists don't cover, you know you've at least tried all the sane/expected things. I personally found that backstop freeing and allowed me to use my creativity when it was demanded by things going wrong.

ncmncm 7y ago
It took three generations of flight training for checklists to become an essential part of aviation. Note that a flight-training generation is less than a human reproductive generation; it's the time from first lesson taken to first lesson taught (plus some). It had to wait for the older instructors to retire. We are still in transition, in medicine. Many physicians have not yet cottoned to hand-washing, yet.
- supahfly_remix 7y ago
  > Many physicians have not yet cottoned to hand-washing, yet. What?!? How many generations has it been since Louis Pasteur?
  - DocTomoe 7y ago
    Actually, Ignaz Semmelweis. And about 150 years, so 4-5 generations of surgeons. Not exactly many.
    - ncmncm 7y ago
      Surgical generations, like pilot generations, are quite a lot shorter than reproductive generations.
  - RyJones 7y ago
    I have bad news for you. I have been seeing a lot of doctors for the last five years or so. Two or three are absolutely fastidious about hand washing. The rest are not.
- euler_angles 7y ago
  Maybe -- and this is just my own opinion/speculation -- this is because in my lines of work, the results of failing to follow a checklist can be at worst catastrophic and relatively immediate. In medicine, some classes of failures might be more subtle and harder to notice. Anyone with medical knowledge, feel free to inform me if that idea is totally off-base.
  - jerf 7y ago
    Also in medicine, it's often not the practitioner who suffers the consequences, which even if we ignore the moral aspects, means the feedback loop isn't closed tightly, making learning more difficult.
- ls612 7y ago
  I don’t know about that last part. My dad is a fairly old physician and the way he tells it hand washing has been mandated by the feds for decades and the last cohort of old docs who refused to change in that respect retired circa 1990. But the culture may be different in other parts of the US or world.
  - JBlue42 7y ago
    Currently work at a hospital. - The CEO's semi-monthly emails have either contained a) reminders to get the flu shot in flu season and b) statements about washing hands. - Thirty minutes of your new employee orientation is used to discuss handwashing with some funny stories about diarrhea and they go around to every single person to make sure they're washing them correctly. - Upon entering a patient room, anyone entering is supposed to wash their hands - Anyone can call out a doctor and ask if they've washed their hands and there are signs to make patients comfortable asking them to do so as well. So yeah, 2019 and people still need all that as reminders.
    - BrandonMarc 7y ago
      I liked how in Freakonomics (I think), they interviewed someone who worked at a hospital, and would regularly and randomly take culture samples of nurses' and doctors' and administrators' hands. The results of the culture were shown on a screensaver. This feedback and public transparency was both amusing, and enforcing of the necessary handwashing.
  - mdpopescu 7y ago
    Ah... you're in for a nasty surprise. [1] Among this cohort, the mean self-estimated handwashing rate was 73% (range, 50%-95%), compared with the covertly observed rate for this cohort of 8.6% before and 10.8% after patient contact, with an individual mean rate of 10% (range, 0-33%). [1] https://www.mja.com.au/journal/1996/164/7/teaching-hospital-medical-staff-handwash https://www.mja.com.au/journal/1996/164/7/teaching-hospital-...
    - BrandonMarc 7y ago
- bsder 7y ago
  > Many physicians have not yet cottoned to hand-washing, yet. This isn't really true. They know it's important. 1) Have you ever washed your hands 12 times a day for a week? Think about what your hands would be like. 2) Washing hands properly takes somewhere around 2 minutes. That's a significant fraction of an hour--just spent washing your hands. Given this, disposable gloves seem like a much better answer.
secfirstmd 7y ago
I started seeing the utility of checklists in the military where we have big books of checklists (battle books or tactical aides) carried in your pocket. The contain everything from how to put in a section in attack to how to call in a helicopter. They are really incredible and so useful under pressure. It gave me the idea to great a free open source mobile app called Umbrella. It's a free, open source app with dozens of best practice lessons and checklists on digital and physical security. The idea being to help people at risk (travellers, journalists, aid workers, activists etc) have somewhere to turn to in an emergency. Everything from sending a secure mail to dealing with a kidnap. You can read more about it at https://www.secfirst.org https://www.secfirst.org or try the checklists for yourself https://itunes.apple.com/us/app/umbrella-security/id1453715310 https://itunes.apple.com/us/app/umbrella-security/id14537153... or https://play.google.com/store/apps/details?id=org.secfirst.umbrella https://play.google.com/store/apps/details?id=org.secfirst.u...

ncmncm 7y ago

It took three generations of flight training for checklists to become an essential part of aviation. Note that a flight-training generation is less than a human reproductive generation; it's the time from first lesson taken to first lesson taught (plus some). It had to wait for the older instructors to retire. We are still in transition, in medicine. Many physicians have not yet cottoned to hand-washing, yet.

supahfly_remix 7y ago
> Many physicians have not yet cottoned to hand-washing, yet. What?!? How many generations has it been since Louis Pasteur?
- DocTomoe 7y ago
  Actually, Ignaz Semmelweis. And about 150 years, so 4-5 generations of surgeons. Not exactly many.
  - ncmncm 7y ago
    Surgical generations, like pilot generations, are quite a lot shorter than reproductive generations.
- RyJones 7y ago
  I have bad news for you. I have been seeing a lot of doctors for the last five years or so. Two or three are absolutely fastidious about hand washing. The rest are not.
euler_angles 7y ago
Maybe -- and this is just my own opinion/speculation -- this is because in my lines of work, the results of failing to follow a checklist can be at worst catastrophic and relatively immediate. In medicine, some classes of failures might be more subtle and harder to notice. Anyone with medical knowledge, feel free to inform me if that idea is totally off-base.
- jerf 7y ago
  Also in medicine, it's often not the practitioner who suffers the consequences, which even if we ignore the moral aspects, means the feedback loop isn't closed tightly, making learning more difficult.
ls612 7y ago
I don’t know about that last part. My dad is a fairly old physician and the way he tells it hand washing has been mandated by the feds for decades and the last cohort of old docs who refused to change in that respect retired circa 1990. But the culture may be different in other parts of the US or world.
- JBlue42 7y ago
  Currently work at a hospital. - The CEO's semi-monthly emails have either contained a) reminders to get the flu shot in flu season and b) statements about washing hands. - Thirty minutes of your new employee orientation is used to discuss handwashing with some funny stories about diarrhea and they go around to every single person to make sure they're washing them correctly. - Upon entering a patient room, anyone entering is supposed to wash their hands - Anyone can call out a doctor and ask if they've washed their hands and there are signs to make patients comfortable asking them to do so as well. So yeah, 2019 and people still need all that as reminders.
  - BrandonMarc 7y ago
    I liked how in Freakonomics (I think), they interviewed someone who worked at a hospital, and would regularly and randomly take culture samples of nurses' and doctors' and administrators' hands. The results of the culture were shown on a screensaver. This feedback and public transparency was both amusing, and enforcing of the necessary handwashing.
- mdpopescu 7y ago
  Ah... you're in for a nasty surprise. [1] Among this cohort, the mean self-estimated handwashing rate was 73% (range, 50%-95%), compared with the covertly observed rate for this cohort of 8.6% before and 10.8% after patient contact, with an individual mean rate of 10% (range, 0-33%). [1] https://www.mja.com.au/journal/1996/164/7/teaching-hospital-medical-staff-handwash https://www.mja.com.au/journal/1996/164/7/teaching-hospital-...
  - BrandonMarc 7y ago
bsder 7y ago
> Many physicians have not yet cottoned to hand-washing, yet. This isn't really true. They know it's important. 1) Have you ever washed your hands 12 times a day for a week? Think about what your hands would be like. 2) Washing hands properly takes somewhere around 2 minutes. That's a significant fraction of an hour--just spent washing your hands. Given this, disposable gloves seem like a much better answer.

secfirstmd 7y ago

I started seeing the utility of checklists in the military where we have big books of checklists (battle books or tactical aides) carried in your pocket. The contain everything from how to put in a section in attack to how to call in a helicopter. They are really incredible and so useful under pressure. It gave me the idea to great a free open source mobile app called Umbrella. It's a free, open source app with dozens of best practice lessons and checklists on digital and physical security. The idea being to help people at risk (travellers, journalists, aid workers, activists etc) have somewhere to turn to in an emergency. Everything from sending a secure mail to dealing with a kidnap. You can read more about it at https://www.secfirst.org https://www.secfirst.org or try the checklists for yourself https://itunes.apple.com/us/app/umbrella-security/id1453715310 https://itunes.apple.com/us/app/umbrella-security/id14537153... or https://play.google.com/store/apps/details?id=org.secfirst.umbrella https://play.google.com/store/apps/details?id=org.secfirst.u...