From The Checklist Manifesto:
We don’t like checklists. They can be painstaking. They’re not much fun. It somehow feels beneath us to use a checklist.
The truly great are daring. They improvise. They do not have protocols and checklists.
Maybe our idea of heroism needs updating.
In modern life, we all depend on systems — on assemblages of people or technologies or both — and among our most profound difficulties is making them work. In medicine, for instance, if I want my patients to receive the best care possible, not only must I do a good job, but a whole collection of diverse components have to mesh together effectively. Health care is like a car that way, points out Donald Berwick, president of the Institute for Healthcare Improvement in Boston and one of our deepest thinkers about systems in medicine. In both cases, having great components is not enough.
In medicine, we’re obsessed with having great components — the best drugs, devices, specialists — but we pay little attention to how to make them fit together well. We have a thirty-billion-dollar-a-year National Institutes of Health, which has been a remarkable powerhouse of medical discoveries. But we have no National Institute of Health Systems Innovation alongside it to study how best to incorporate these discoveries into daily practice — no NTSB equivalent swooping in to study failures the way crash investigators do, no Boeing mapping out the checklists, no agency tracking the month-to-month results.
The same can be said in numerous other fields. We don’t study routine failures in teaching, in law, in government programs, or in the financial industry. We don’t look for patterns of recurrent mistakes or devise and refine potential solutions for them.
But we could. And this is the point. We are all plagued by failures — by missed subtleties, overlooked knowledge, outright errors. For the most part, we have imagined that little can be done beyond working harder to catch the problems and clean up after them. We are not in the habit of thinking the way army pilots did as they looked upon their shiny new Model 299 bomber — a machine so complex no one was sure human beings could fly it. They too could have decided just to “try harder” or to dismiss a crash as the failings of a “weak” pilot. Instead they chose to accept their fallibilities. They recognized the simplicity and power of using a checklist.
So can we. Indeed, against the complexity of the world, we must. When we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It’s time to try something else.
Try a checklist. ( See below )
No matter how routine a surgical operation is, the patients never seem to be. But with a checklist in place, my team and I have caught unrecognized drug allergies, equipment problems, confusion about medications, mistakes on labels for biopsy specimens going to pathology. We’ve made better plans and been better prepared for patients.
I am not sure how many important issues would have slipped by us without the checklist and actually caused harm.
From The Checklist Manifesto: How to Get Things Right, copyright © 2009 by Atul Gawande, published by Metropolitan Books, a division of Henry Holt and Company, LLC. Used by permission of the publisher.
