Thanks to my friend Amber for telling me about Dr. Atul Gawande's interview on NPR's Morning Edition yesterday. Regular readers of the blog will know I'm a huge fan of Gawande's previous books Complications: A Surgeon's Notes on an Imperfect Science and Better: A Surgeon's Notes on Performance.
I'm really looking forward to reading his latest book The Checklist Manifesto: How to Get Things Right (actually, I read the first two chapters last night).
On NPR, Gawande talked about the power of checklists in manufacturing (Boeing), aviation (citing Capt. Sully) and operating rooms. And he shared a surprising detail about his work…
It's not a surprise to Lean Thinkers that checklists work. Gawande said:
“We get better results,” he says. “Massively better results.”
“We caught basic mistakes and some of that stupid stuff,” Gawande reports.
The mystery is why checklists haven't spread more quickly, why they aren't being used everywhere.
Simple basic teamwork (as taught in the Crew Resource Management approach, also from aviation) can also make a huge difference.
“Like making sure everyone in the operating room knows each other by name. When introductions were made before a surgery, Gawande says, the average number of complications and deaths dipped by 35 percent.
“Making sure everybody knew each other's name produced what they called an activation phenomenon,” Gawande explains. “The person, having gotten a chance to voice their name, let speak in the room — were much more likely to speak up later if they saw a problem.”
Gawande recounts how surgeons in his trials were resistance to the new idea. After initial use (and the successful results), 20% still thought they didn't need the checklist. This is a phenomenon that Gawande has written about before, that many doctors think checklists are for “the other guy,” that they won't make mistakes.
But what about our good Dr. Gawande? He admitted HE was resistant, blaming, it seemed Harvard Medical School arrogance.
Despite all the evidence, Gawande admits that even he was skeptical that using a checklist in everyday practice would help to save the lives of his patients.
“I didn't expect it,” Gawande says with a chuckle. “It's massively improved the kind of results that I'm getting. When we implemented this checklist in eight other hospitals, I started using it because I didn't want to be a hypocrite. But hey, I'm at Harvard, did I need a checklist? No.”
Or so he thought.
“I was in that 20 percent. I have not gotten through a week of surgery where the checklist has not caught a problem.”
So this is an “evidence-based” profession? Are checklists being used by all of the surgeons in your local hospital?
I'm going to blog soon about a video that was made by the CDC to educate patients about the need for their caregivers to perform proper hand hygiene. Is the CDC producing a video encouraging patients and families to not be afraid to ask their surgeon if they're using a checklist?
On Twitter yesterday, “@shmula” (Pete Abilla) alerted me that @Tom_Peters tweeted this:
If doctors are so smart, why did it take them until 2010 to "invent" checklists? (See Dr Atul Gawande's book "The Checklist Manifesto.")
— Tom Peters (@tom_peters) January 5, 2010
And:
If doctors are so smart, why can't the learn to wash their hands?
— Tom Peters (@tom_peters) January 5, 2010
He probably knows this, but it's not a matter of “smart.” It's a matter of focus and leadership. It's a matter of being willing to learn from other industries and not having to invent it all yourself…
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Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.
He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean.
Mark is also a Senior Advisor to the technology company KaiNexus.
Hi Mark,
Thanks for making Dr. Gawande’s work visible. We are huge fans at Group Health and have been using checklist with great results. For anyone out there that have not had a chance to read his articles in the New Yorker or his book “Better” I would highly recommend them.
Take care,
Lee
Thanks for the mention, Mark. It was my pleasure to forward this on to you.
I found an additional comment by Dr. Gawande’s on the 20% who still felt they didn’t need checklists particularly illuminating… They asked this group why they were opposed to the checklists and were told, “This is a waste of my time, I don’t think it makes any difference.” And then they asked them, “If you were to have an operation, would you want the checklist?” 94% wanted the checklist!
Very interesting and usefull. Thanks. I didn’t know Dr. Gawande before so i appreciate.
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