Last night, BBC2’s Horizon was all about how to avoid mistakes in surgery. A&E doctor Kevin Fong investigated how doctors can avoid making mistakes in the high-pressure, high-stakes world of the operating theatre.
The answer, it turned out, was the humble checklist. Now, being a Myers Briggs ISTJ personality type, this came as no surprise to me and, with my Continuous Improvement hat on, it also made a lot of sense. I have lists for (almost) everything, but I don’t quite have a list of lists, yet.
One of the references in the programme was to Atul Gawande’s book about checklists, The Checklist Manifesto. The book’s main point is simple: no matter how expert you may be, well-designed checklists can improve outcomes (even for Gawande’s own surgical team). The best-known use of checklists is by airplane pilots.
In surgery, the evidence seems dramatic, with errors and patient complications reduced by factors of 30-50%.
Interestingly, one of the reasons for checklists being so valuable is that they force people in teams to talk to each other. Making sure everybody knew each other’s name in the operating theatre before starting a procedure produced what they called an activation phenomenon. Each person in the team, having had a chance to voice their name, was much more likely to speak up later if they saw a problem. This simple act, in one hospital, resulted in the average number of complications and deaths dropping by 35 percent.
One of the other things that was discussed in the Horizon programme was the fact that people, when faced with a crisis, often end-up taking a very narrow view of the options they have. They fail to see the bigger picture. The use of checklists, reduces this risk.
Perhaps unsurprisingly, Gawande’s website even has a checklist for checklists.