Checklists and Standardized Work in Patient Care

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New Yorker – Dr. Atul Gawande

Here is an outstanding piece by one of my favorite medical writers, on the use of checklists (a form of Standardized Work) to improve healthcare quality.

How can “a stupid little checklist” have such an impact? Take a look at the article and see.

Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative's first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

Standardized Work and Lean (I'll call this article an example of “Lean” even though Gawande doesn't) are not glamorous. This isn't an exciting new drug or a flashy “gee whiz” technology. This is basic process management and kaizen 101… yet it's so effective. We need more of this in our hospitals…

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent book is the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus. His latest book has been released as an "in-progress" book, titled Measures of Success.

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5 Comments
  1. Joe says

    Oh Mark, you beat me to it!! I just got this article last night, read it and have it earmarked for our management team. And I was up, bright and early, to email you to see if you’d seen it.

    Yep, you have!!!

    This is a profound article. And, as one working in the medical device business, the data are amazing. There is no technological whiz-bang cool thing that can impact patient health NEARLY as much as what the author describes.

    Stay on this one Mark, I will too from my side. If we SAY we are all about patient health, we have to bring this message to bear. There is much here to consider.

    Note: have you considered getting Tom Peters’ attention on this one?? He has a HUGE voice and cares passionately about health care and has quoted Gawande many times before. I laid in bed last night thinking about how to get Peters’ voice on this one. Whaddaya think??

  2. Anonymous says

    One aspect that is important here is the way this is presented to the front-line employee.

    It needs to be presented as “This is a tool for you, as an intelligent, decision-making individual, to use to minimize errors and accomplish more”. And get them involved in creating and refining the procedures.

    If employees feel they are being reduced to rote-work checking off boxes on yet another piece of paperwork, in a punishment-and-enforcement-oriented atmosphere, improvements may be minor.

    Like so much of lean management, the work environment determines the success or failure of these methods long before they are introduced.

  3. Bryan says

    Like Standardized Work within the Toyota Produciton System, there is probably information that is highly meaningful to the person doing the job on that checklist. Standardized work is more than a sheet of paper, it is THE amazing oversight we in North America have made in estimating the effectiveness of TPS while only considering what we could see: kanban, SMED, workcells, takt time and poke-yoke devices. We have yet to open our eyes.

  4. […] those of you catching up on this story, here’s my original blog post about the use of checklists at Johns Hopkins and the follow up about the government putting a stop to the program. “We do not want to stand in […]

  5. […] of you have emailed me, yes I’m aware of this horrible, ridiculous development that followed earlier reports of the success hospitals were having in reducing infections and improving patient ca… (a form of Standardized Work) that aren’t stupid at all. They’re so simple, […]

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