Checklists and Error Prevention on the TV Show ER
Hulu – ER: Old Times – Watch the full episode now. Thanks to Bryan to bringing this episode of ER to my attention. I don’t normally watch it, but my wife always DVRs it, so I was able to watch…
Hulu – ER: Old Times – Watch the full episode now. Thanks to Bryan to bringing this episode of ER to my attention. I don’t normally watch it, but my wife always DVRs it, so I was able to watch…
There’s so much in the news about “checklists” in the medical context… and I’m convinced that it’s basically the Lean “standardized work” approach in a different name. Checklists help prevent people from making mistakes of omission — forgetting a step…
Thinking back to a letter-to-the-editor that I mentioned last week, this is such a critical point, I wanted to think and write about it again, especially since it was in the comments and not everyone sees that. It’s not the…
WHO Proposes Checklist to Reduce Surgery Errors : NPR A surgical revolution: checklist that could prevent thousands of deaths Thanks to long-time readers Chet and Andrew for pointing out these similar stories, one from NPR in the U.S. and one…
Peter Pronovost – The 2008 TIME 100 – TIME It’s so nice to see someone like Dr. Peter Pronovost on the “most influential” list, even though he’s out of place among the Miley Cyruses of the world (also on the…
Wachter’s World : The Checklist Saga: Victory! This is great news for patients and is probably great news for those of you who have been following the “checklists” saga. The federal government has reversed its earlier decision to shutdown the…
A Lifesaving Checklist – New York Times A number 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 care through…
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 executive says, after hearing about a major quality defect: “You said we solved that. Why’d the problem come back???” That might sound like an attempt at accountability. But it’s not necessarily Lean thinking. The “Study” step of the Plan-Do-Study-Adjust…

Why do so many quality programs fall apart the moment the firefighter walks out the door? In this conversation, Chad Diggs talks about his new book, Below the Surface, and what it takes to build quality systems that outlast the people who…

Three years ago, The Mistakes That Make Us came out. Around the same time, Elisabeth Swan published Picture Yourself a Leader. Both books’ third birthdays felt like a decent reason to get together and talk together and bring in some…

TL;DR: Lean daily management is the system that makes improvement happen between the projects — visual boards, huddles, gemba walks, leader standard work, and strategy alignment working together. The boards don’t do the work. The leadership behaviors do. Most Lean…