This week in our health policy class we watched a Ted Talk given by Atul Gawande titled "How do we heal medicine?" One of the most interesting things he talked about was this idea of designing a checklist for surgeons to complete before and after surgery. He created a 19 item checklist to give to not only new surgeons, but older, experienced ones as well. I found this interesting because it can be easy to assume that a very experienced surgeon wouldn't need any help or guidance when it comes to performing the surgery.
Gawande implemented his checklist in eight different hospitals around the world, from Tanzania to Seattle, Washington. The results he found were astonishing. The complication rates in these hospitals dropped 35 percent, and the death rates dropped 47 percent. There was an improvement in every single hospital. I found it crazy how something so simple could have such a dramatic effect on something as serious as the death rate.
As a manager, it is important to always be open to ways to improve your organization. A hospital administrator may have looked at something as simple as a checklist and not think the surgeons needed it. There are constantly new studies coming out in health care about what does and does not work and as an administrator it is important to keep updated on those things, because they could help you improve the way you care for patients.
Source:
Gawande, A. (2012, February). Atul Gawande: How do we heal medicine? [Video file]. Retrieved
from https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine
Hi Nicole,
ReplyDeleteGreat post, checklists are SO important in health care. Checklists can be helpful for so many areas, from HR onboarding, to security, to staffing, to of course clinical processes. Not only do checklists ensure that steps are not missed, but they also help with creating accountability, especially if folks are initialing the steps that they complete. I have implemented various checklists in my role, for example the three staff members who do the medical supply ordering for the ED have a daily checklist of all the things that need to be ordered/stocked/checked because we can't risk "forgetting" to do something in the ED environment.
We are working with the Environmental Services Department now to create a room turnover checklist to ensure that priority things like removing blood tubes or checking underneath the bed are not missed.
Hi Sarah,
DeleteThanks for the comment. That's really cool that you have implemented checklists in your own organization. I think its important to remember that checklists can be helpful at every level of an organization, from surgery to Environmental Services.
Nice job blending the streams from your two classes.
ReplyDeleteI love this idea from several perspectives:
ReplyDeleteFirst, I've been a pilot for 41 years. While in flight school, the use of checklists was mandatory and was drilled into our heads. (One just can't pull over at 10,000 feet altitude because you forgot to check the engine oil while on the ground preflight). Forget to use the cheklist, or arrogantly skip some lines, and you risk turning into a lawn dart.
Second, I've been an anesthetist for 25 years. There are countless psychomotor and intellectual similarities between piloting and giving anesthesia (which is probably what attracted me to the career). While in clinical training I noticed a lack of pre-operative checklists on my first day, and I commented about that to my instructor. She responded that "we just know what to do." I created my own checklist and quickly had many classmates ask for a copy. I've never regretted it.
Now ... trying to get surgeons to use a pre-incision checklist is an uphill battle. In years past, surgeons generally felt like they were God. The newer generation is coming around to the idea of checklists, but still there's some gentle resistance. I personally feel like state law, hospital medical staff bylaws, and Joint Commission should absolutely mandate checklists with STIFF penalities for blowing them off, and (as I have witnessed) no longer allow the "wink wink, nod nod" approach to rushing through a checklist.
I have personal experience with this: my wife was brought into the operating room for knee surgery, using a surgeon, RN, and anesthestist I personally requested. The checklist stopped the process in time: she was in an OR in Louisiana, while her knee implant was in Houston. Needless to say the surgeon had a few choice words for the implant manufacuter's representative who was present.
Checklists work. The FAA mandates their use in aviation. So should medicine.
Hi Don,
DeleteThanks for the comment. It is really interesting to hear about your experience with checklists in not only your career in healthcare but also as a pilot. I agree with you that there should be a mandate for checklists that is strictly enforced. There is no cost involved with implementing a checklist and it could not only save the organization money in the long run, but more importantly save lives.