Comments on: Checklists and How You Manage Them http://www.leanblog.org/2008/07/checklists-and-how-you-manage-them/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Fri, 10 Feb 2012 10:01:31 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Anonymous http://www.leanblog.org/2008/07/checklists-and-how-you-manage-them/#comment-3740 Anonymous Thu, 10 Jul 2008 16:59:00 +0000 http://leanblog.bigbigdesign.net/2008/07/checklists-and-how-you-manage-them/#comment-3740 The leadership aspect will become even more important as EMR’s are further developed. The movement now is to build the checklist into the medical record. <br/><br/>But I have seen several situations where people just blindly click through the checks in the medical record. I think it is important for the healthcare industry to realize that a quality EMR is just as useless as a quality checklist if the leadership is not prepared to hold people to the standard. The leadership aspect will become even more important as EMR’s are further developed. The movement now is to build the checklist into the medical record.

But I have seen several situations where people just blindly click through the checks in the medical record. I think it is important for the healthcare industry to realize that a quality EMR is just as useless as a quality checklist if the leadership is not prepared to hold people to the standard.

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]]> By: Adam Zak http://www.leanblog.org/2008/07/checklists-and-how-you-manage-them/#comment-3739 Adam Zak Thu, 10 Jul 2008 15:30:00 +0000 http://leanblog.bigbigdesign.net/2008/07/checklists-and-how-you-manage-them/#comment-3739 Right on target.<br/><br/>I've been doing a bit of research on the use of checklists across industries (think pilots in the cockpit prior to take-off, surgeons preparing for a patient surgery, etc.), and I ran across an article in <b>Fast Company</b> magazine from March, 2008, which mentioned a checklist created by Dr. Peter Pronovost of the Johns Hopkins University School of Medicine.<br/><br/>Authors Dan and Chip Heath say: "The checklist contained straightforward advice. Doctors should wash their hands before inserting in IV, a patient's skin should be cleaned with antiseptic at the point of insertion, and so forth. There was no new science and nothing controversial-only the results were suprising." <br/><br/>Apparently, after implementing this checklist, Michigan ICUs virtually eliminated line infections, saved $175 million by not having to treat associated complications, and they saved about 1,500 lives (over an 18 month period). So, how did Michigan ICUs (perhaps others, but not noted in the article) get medical staffers to implement and actually use this checklist?<br/><br/>The Heath brothers address this: "Provonost learned to fight the resistance by appealing to a value they all shared-patient health." <br/><br/>In other words, he found common ground, built trust, and reached agreement and consensus as today's true leaders do. Not by issuing edicts and commands but by expressing and sharing values, and engaging those around them with purpose and confidence.<br/><br/>The Heaths continue: "He (Pronovost) would bring doctors and nurses together and ask 'Would you ever intentionally allow a patient's health to be harmed in your presence?' They'd say 'Of course not.' Then he'd hit them with the punch line: 'Then how can you see someone not washing their hands and let them get away with it?'"<br/><br/>So, yes, leaders can, and indeed must, lead without issuing edicts and mandates. Our challenge is to find and develop such leaders in all industries and organizations, and at all levels. It's not just about Dr. Pronovost, it's about all the doctors and nurses on every shift around the clock, and their personal leadership in the Gemba.<br/><br/>Adam Zak Right on target.

I’ve been doing a bit of research on the use of checklists across industries (think pilots in the cockpit prior to take-off, surgeons preparing for a patient surgery, etc.), and I ran across an article in Fast Company magazine from March, 2008, which mentioned a checklist created by Dr. Peter Pronovost of the Johns Hopkins University School of Medicine.

Authors Dan and Chip Heath say: “The checklist contained straightforward advice. Doctors should wash their hands before inserting in IV, a patient’s skin should be cleaned with antiseptic at the point of insertion, and so forth. There was no new science and nothing controversial-only the results were suprising.”

Apparently, after implementing this checklist, Michigan ICUs virtually eliminated line infections, saved $175 million by not having to treat associated complications, and they saved about 1,500 lives (over an 18 month period). So, how did Michigan ICUs (perhaps others, but not noted in the article) get medical staffers to implement and actually use this checklist?

The Heath brothers address this: “Provonost learned to fight the resistance by appealing to a value they all shared-patient health.”

In other words, he found common ground, built trust, and reached agreement and consensus as today’s true leaders do. Not by issuing edicts and commands but by expressing and sharing values, and engaging those around them with purpose and confidence.

The Heaths continue: “He (Pronovost) would bring doctors and nurses together and ask ‘Would you ever intentionally allow a patient’s health to be harmed in your presence?’ They’d say ‘Of course not.’ Then he’d hit them with the punch line: ‘Then how can you see someone not washing their hands and let them get away with it?’”

So, yes, leaders can, and indeed must, lead without issuing edicts and mandates. Our challenge is to find and develop such leaders in all industries and organizations, and at all levels. It’s not just about Dr. Pronovost, it’s about all the doctors and nurses on every shift around the clock, and their personal leadership in the Gemba.

Adam Zak

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]]> By: Erik http://www.leanblog.org/2008/07/checklists-and-how-you-manage-them/#comment-3738 Erik Thu, 10 Jul 2008 09:48:00 +0000 http://leanblog.bigbigdesign.net/2008/07/checklists-and-how-you-manage-them/#comment-3738 I think something that is also critical with checklists is somehow documenting WHY we are checking this point. Too often, something is started, because of a certain set of conditions in the past. However, years later, you review the checklist to improve it, and see a check which looks redundant or uneccesary, and having a field where you can see the WHY of a check. I think something that is also critical with checklists is somehow documenting WHY we are checking this point. Too often, something is started, because of a certain set of conditions in the past. However, years later, you review the checklist to improve it, and see a check which looks redundant or uneccesary, and having a field where you can see the WHY of a check.

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]]> By: Anonymous http://www.leanblog.org/2008/07/checklists-and-how-you-manage-them/#comment-3737 Anonymous Thu, 10 Jul 2008 06:28:00 +0000 http://leanblog.bigbigdesign.net/2008/07/checklists-and-how-you-manage-them/#comment-3737 Excellent thoughts. As "checklists" get rolled out, I'm afraid people will think they are "easy" or a "silver bullet." We need people to be leaders, implementing stuff like this (*really using it*) isn't easy, as you point out. Excellent thoughts. As “checklists” get rolled out, I’m afraid people will think they are “easy” or a “silver bullet.” We need people to be leaders, implementing stuff like this (*really using it*) isn’t easy, as you point out.

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