4 ms·

I wonder. Does the Hawthorne Effect (https://en.wikipedia.org/wiki/Hawthorne_effect https://en.wikipedia.org/wiki/Hawthorne_effect) contribute to the success of

I wonder. Does the Hawthorne Effect (https://en.wikipedia.org/wiki/Hawthorne_effect https://en.wikipedia.org/wiki/Hawthorne_effect) contribute to the success of these checklist regimes? When surgical or emergency-department teams believe they're participating in an experiment to learn whether certain practices improve outcomes, do the outcomes improve? Airplane pilots use checklists. It's illegal to start the engines unless the approved checklist book is within reach of the pilot in command. In training it's drilled into us that the response to panic is: get out the checklist and follow it. It works. duh. It's all too easy under pressure to forget to lower the wheels or turn on the carburetor heat, or whatever. The drilling in training is what makes the difference. (Aviation gasoline cools as it vaporizes in carburetors. Under certain conditions that can make the carburetor fill up with ice. If that happens the airplane will land soon. Not good. So carburetors have heaters. ) Checklists have far less success in medicine. Heck, almost two centuries ago Dr. Ignatz Semmelweis (https://en.wikipedia.org/wiki/Ignaz_Semmelweis https://en.wikipedia.org/wiki/Ignaz_Semmelweis) found that patients lived a lot longer when doctors and nurses washed their hands. But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. Maybe something about medical training makes people resistant to fixed procedures. Maybe it's the age-old practice of eminence-based medicine rather than evidence-based medicine. It's a serious problem.

sjg007 7y ago
Gloves are another one.. blows my mind.
perl4ever 7y ago
Without any specific relevant experience in a hospital, isn't the most likely reason procedures fail that people are required to ignore/bypass parts of them constantly, rather than having them updated to match reality? It seems so very obvious to me that any time you start asking, from a 40,000 foot level, why people can't follow simple instructions, the answer is going to be, not that they are all idiots, but that they are trained and required to ignore them selectively based on complex ever shifting criteria. That is basically what makes any job require a human and not a computer in the first place. The more rigid you want people to be, the better the process has to be.
mbesto 7y ago
> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. I think it's more likely that there is an immediate feedback loop to disregarding the checklist (i.e. the plane crashes and the pilot dies), whereas not washing your hands has a lot more delayed consequences in which the causation isn't readily known. I think this is the general problem with Outcomes Based Health - we have the stats to back up its effectiveness, but don't have the immediate feedback loops to promote it.
AmericanChopper 7y ago
> In training it's drilled into us that the response to panic is: get out the checklist and follow it I do this, and always teach others to do this, during incident response. The reason I think it works is it reduces your burden for making decisions during a stressful time. No matter who you are, how good you are at managing stress, or how experienced you are, you’ll almost always end up making worse decisions under pressure, so removing the need to make decisions as much as possible seems to generally lead to better outcomes.
mschuster91 7y ago
> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. Ever talked with a nurse or a doctor? The reason is simple: way, way not enough staff at hand combined with maximum allowed/planned time for a certain procedure (e.g. 10 minutes for a full assisted shower) which only works in perfect conditions but falls apart under the slightest change (e.g. patient wet themselves), and combined with ruthless MBA-style C-level execs actually firing people for not keeping up with the numbers. Medicine, especially highly critical / urgent care, needs to be socialized and shielded off from all negative effects of modern-day capitalism if this is to change.
- sarcasmOrTears 7y ago
  You want to solve a problem caused by shortages with policies that historically always causes shortages? (Socialism) Medicine is heavily regulated everywhere and people always complain about the same problems in the US and Europe, and these problems are the same kind of problems caused by regulation and guild-like organizations all around the world, in all industries at all points in time. Even if you were to let someone else pay the bill, it's idiotic to have things organized as they're now.
  - mschuster91 7y ago
    > You want to solve a problem caused by shortages with policies that historically always causes shortages? (Socialism) Introducing socialized single payer healthcare is not socialism, no matter what the Republicans are spouting.
    - sarcasmOrTears 7y ago
      You still create a problem with prices since if everything is payed by the State, the pay is arbitrary
      - mschuster91 7y ago
        > You still create a problem with prices since if everything is payed by the State, the pay is arbitrary No, it's no problem there. Raw materials / medicine, consumables, land, energy, work itself - everything has a price and thus a proper socialized healthcare system can account for everything, while putting patient outcome first and not money/profit.
redis_mlc 7y ago
> Airplane pilots use checklists. It's illegal to start the engines unless the approved checklist book is within reach of the pilot in command. In training it's drilled into us that the response to panic is: get out the checklist and follow it. It works. Just some clarifications: - It's not illegal to fly without a checklist under Part 91 (non air-carriers.) When I fly with military pilots, they use a flow for starting small airplanes: http://fsims.faa.gov/PICDetail.aspx?docId=8900.1,Vol.3,Ch32,Sec12 http://fsims.faa.gov/PICDetail.aspx?docId=8900.1,Vol.3,Ch32,... - the airplane manual is a book, and must be on the airplane. A checklist is a list, not a manual. The checklist can be electronic, as in the HondaJet. - it's a good idea to follow the emergency procedures either from memory, or a checklist if there's time. Typically recovering from a stall or spin, or feathering a bad engine is done from memory, for example. Source: commercially-rated airplane pilot.
bsder 7y ago
> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. Wash your hands 12 times a day for a week and you'll understand why people might not want to comply. I want my doctor to wash his hands, but I can at least sympathize as to why he might not want to.
- jmb12686 7y ago
  I have twin infants, a toddler, and work in a large office unrelated to medicine. I wash my hands on average 2 * 12 times a day, every day. It's my job to keep my family healthy. I suppose we are saying it is arguable that it's not the job of medical professionals to keep their patients healthy? Hippocratic oath must be window dressing these days.
  - waterhouse 7y ago
    When you say you "wash" your hands, do you do a full "apply soap to all sides of hands" every time? Personally, I rinse my hands (i.e. with only water) pretty frequently, but only wash with soap when the occasion calls for it (when arriving home, when my hands are greasy, or after sitting at the toilet), which probably averages 2-3 times per day. On a separate note, my family doctor used some kind of antiseptic and moisturizing lotion on his hands. He said the antiseptic would tend to dry the skin, so adding a moisturizing element to it was a genius idea and whoever came up with it was probably making millions.
  - bsder 7y ago
    > I wash my hands on average 2 * 12 times a day, every day. I simply don't believe you. That would imply that you spend almost an hour per day washing your hands if you are following proper hand hygiene. With twin infants and a toddler, I'm pretty sure you simply don't have that kind of time in a day.

sjg007 7y ago

Gloves are another one.. blows my mind.

perl4ever 7y ago

Without any specific relevant experience in a hospital, isn't the most likely reason procedures fail that people are required to ignore/bypass parts of them constantly, rather than having them updated to match reality? It seems so very obvious to me that any time you start asking, from a 40,000 foot level, why people can't follow simple instructions, the answer is going to be, not that they are all idiots, but that they are trained and required to ignore them selectively based on complex ever shifting criteria. That is basically what makes any job require a human and not a computer in the first place. The more rigid you want people to be, the better the process has to be.

mbesto 7y ago

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. I think it's more likely that there is an immediate feedback loop to disregarding the checklist (i.e. the plane crashes and the pilot dies), whereas not washing your hands has a lot more delayed consequences in which the causation isn't readily known. I think this is the general problem with Outcomes Based Health - we have the stats to back up its effectiveness, but don't have the immediate feedback loops to promote it.

AmericanChopper 7y ago

> In training it's drilled into us that the response to panic is: get out the checklist and follow it I do this, and always teach others to do this, during incident response. The reason I think it works is it reduces your burden for making decisions during a stressful time. No matter who you are, how good you are at managing stress, or how experienced you are, you’ll almost always end up making worse decisions under pressure, so removing the need to make decisions as much as possible seems to generally lead to better outcomes.

mschuster91 7y ago

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. Ever talked with a nurse or a doctor? The reason is simple: way, way not enough staff at hand combined with maximum allowed/planned time for a certain procedure (e.g. 10 minutes for a full assisted shower) which only works in perfect conditions but falls apart under the slightest change (e.g. patient wet themselves), and combined with ruthless MBA-style C-level execs actually firing people for not keeping up with the numbers. Medicine, especially highly critical / urgent care, needs to be socialized and shielded off from all negative effects of modern-day capitalism if this is to change.

sarcasmOrTears 7y ago
You want to solve a problem caused by shortages with policies that historically always causes shortages? (Socialism) Medicine is heavily regulated everywhere and people always complain about the same problems in the US and Europe, and these problems are the same kind of problems caused by regulation and guild-like organizations all around the world, in all industries at all points in time. Even if you were to let someone else pay the bill, it's idiotic to have things organized as they're now.
- mschuster91 7y ago
  > You want to solve a problem caused by shortages with policies that historically always causes shortages? (Socialism) Introducing socialized single payer healthcare is not socialism, no matter what the Republicans are spouting.
  - sarcasmOrTears 7y ago
    You still create a problem with prices since if everything is payed by the State, the pay is arbitrary
    - mschuster91 7y ago
      > You still create a problem with prices since if everything is payed by the State, the pay is arbitrary No, it's no problem there. Raw materials / medicine, consumables, land, energy, work itself - everything has a price and thus a proper socialized healthcare system can account for everything, while putting patient outcome first and not money/profit.

redis_mlc 7y ago

> Airplane pilots use checklists. It's illegal to start the engines unless the approved checklist book is within reach of the pilot in command. In training it's drilled into us that the response to panic is: get out the checklist and follow it. It works. Just some clarifications: - It's not illegal to fly without a checklist under Part 91 (non air-carriers.) When I fly with military pilots, they use a flow for starting small airplanes: http://fsims.faa.gov/PICDetail.aspx?docId=8900.1,Vol.3,Ch32,Sec12 http://fsims.faa.gov/PICDetail.aspx?docId=8900.1,Vol.3,Ch32,... - the airplane manual is a book, and must be on the airplane. A checklist is a list, not a manual. The checklist can be electronic, as in the HondaJet. - it's a good idea to follow the emergency procedures either from memory, or a checklist if there's time. Typically recovering from a stall or spin, or feathering a bad engine is done from memory, for example. Source: commercially-rated airplane pilot.

bsder 7y ago

> But, even in the 21st century, it's a struggle to get compliance with hand-washing rules in hospitals. Wash your hands 12 times a day for a week and you'll understand why people might not want to comply. I want my doctor to wash his hands, but I can at least sympathize as to why he might not want to.

jmb12686 7y ago
I have twin infants, a toddler, and work in a large office unrelated to medicine. I wash my hands on average 2 * 12 times a day, every day. It's my job to keep my family healthy. I suppose we are saying it is arguable that it's not the job of medical professionals to keep their patients healthy? Hippocratic oath must be window dressing these days.
- waterhouse 7y ago
  When you say you "wash" your hands, do you do a full "apply soap to all sides of hands" every time? Personally, I rinse my hands (i.e. with only water) pretty frequently, but only wash with soap when the occasion calls for it (when arriving home, when my hands are greasy, or after sitting at the toilet), which probably averages 2-3 times per day. On a separate note, my family doctor used some kind of antiseptic and moisturizing lotion on his hands. He said the antiseptic would tend to dry the skin, so adding a moisturizing element to it was a genius idea and whoever came up with it was probably making millions.
- bsder 7y ago
  > I wash my hands on average 2 * 12 times a day, every day. I simply don't believe you. That would imply that you spend almost an hour per day washing your hands if you are following proper hand hygiene. With twin infants and a toddler, I'm pretty sure you simply don't have that kind of time in a day.