Why doctors need a checklist
As the global rates of surgery grew, so did the damage: A million patients a year died during medical procedures and more than 7 million were left disabled. The World Health Organization turned to Dr. Atul Gawande to come up with a low-cost solution.
He developed a pre-operation checklist, which the WHO tried out in eight hospitals with remarkable results. Deaths fell 47 percent, while complications dropped by more than a third. It didn't matter how high-tech or how poor the hospital was - the results were significant across the board.
In his latest book, "The Checklist Manifesto: How to Get Things Right" (Metropolitan Books, $24.50), surgeon and MacArthur Award winner Gawande argues that the complexity that now characterizes many fields, ranging from architecture to venture capitalism, can be tamed with a humble tool.
Q: How does a simple checklist help?A: In medicine, we're overwhelmed by the volume of knowledge and information we have to handle. A checklist fills in for weaknesses in our brains, like memory, and helps us work more successfully as teams.Q: Why does the checklist have such a bad rap?A: One is sheer embarrassment - if you're an expert, you're better than that. It's thought to dumb things down rather being about the nuance. Plus a lot of us hate following instructions. We've had experiences where it can get in the way, where the rigidity of rules makes for bad results.Q: What's a good checklist?A: This is where science comes in to it. A good checklist actually improves the ability of an expert to do a job well. It has to be tested in the real world with feedback from the people on the front lines. When it works, it helps performance without any improvement in skill.Q: Does the checklist function differently in an emergency, such as when Sully Sullenberger successfully landed his plane in the Hudson?A: We wanted to say it was the heroism of the individual. He responded by saying it was about adherence to protocol and teamwork, so we said he was just being modest. When the engines went out, he could count on the co-pilot to run through the checks, so he could focus on the one key thing that couldn't be reduced to a checklist, "Where am I going to land this plane?"Q: In your New Yorker article on expensive health care in McAllen, Texas, you showed what happens when the patient is regarded as a profit center. What response did you get?A: I've never had an article so widely read. There is a battle in the culture of medicine between a desire to run a successful business and the recognition that the patient's needs have to come first over any kind of business requirement. We have a health system where doing great at the medical business is not necessarily what is great for patients. The most damning thing about the costs of our system is that the doctors who get the best results are not the ones who are the most expensive. Often they are the least expensive.