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A Life-Saving Checklist (2007)

newyorker.com

11–20 of 47 posts

Re: A Life-Saving Checklist (2007)

#11
"The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. . . ."

Indeed, benefits of checklists can be huge. this reminds me of a US Army study I read about some time ago which examined the effects of sleep deprivation and stress in demanding environments.

What they found was that, in general, the high-level strategic capabilities stayed intact -- the people could still analyze complex situations, make and execute battle plans, etc.

What was lost was the smaller, mundane functions, which could add up to critical failures, such as forgetting to refill one's water can or refuel the vehicle before going out, etc.

Interesting lesson

Re: A Life-Saving Checklist (2007)

#12
In his book, The Checklist Manifesto, Gawande reports that at the end of a big checklist pilot project for the World Health Organization (IIRC), participating surgeons were surveyed.

• One of the survey questions was, in essence: Would the use of checklists improve your surgical practice? Most of the surgeons responded no. This was consistent with the resistance that Gawande encountered: I don't need no stinking checklist; I'm a good surgeon!

• But the more-telling survey question was this: Would you want another surgeon to use a checklist if operating on you or one of your family members? Something like 93% of the surgeons surveyed responded ... yes.

Re: A Life-Saving Checklist (2007)

#13
post #3

(2007) This probably got posted in reaction to the news that the author, Atul Gawande, was announced to be the CEO of a new healthcare company. https://news.ycombinator.com/item?id=17355346

It seems like these two articles are more relevant:

https://www.newyorker.com/magazine/2009/06/01/the-cost-conun...

https://www.newyorker.com/magazine/2015/05/11/overkill-atul-...

Re: A Life-Saving Checklist (2007)

#14
I have a dumbass problem where after I've driven away from home I can't remember if I locked the front door or closed the garage door so I turn around and go back home to check. I've managed to fix this by saying out loud, "door locked - check" and "garage door down - check" when I've done it. Now I just need a checklist to remind me to do a checklist.

Re: A Life-Saving Checklist (2007)

#15

I have a dumbass problem where after I've driven away from home I can't remember if I locked the front door or closed the garage door so I turn around and go back home to check. I've managed to fix this by saying out loud, "door locked - check" and "garage door down - check" when I've done it. Now I just need a checklist to remind me to do a checklist.

It might sound dumb to you but your solution is used by Japanese train engineers before leaving at a station and trains in Japan are really efficient and on-schedule.

https://www.allaboutlean.com/pointing-and-calling/

Re: A Life-Saving Checklist (2007)

#16
post #12

In his book, The Checklist Manifesto, Gawande reports that at the end of a big checklist pilot project for the World Health Organization (IIRC), participating surgeons were surveyed. • One of the survey questions was, in essence: Would the use of checklists improve your surgical practice? Most of the surgeons responded no. This was consistent with the resistance that Gawande encountered: I don't need no stinking chec…

Wow. That's such a supreme indicator of overconfidence--the belief that I and I alone am so competent that I don't need safeguards.

I would not have hoped that a high percentage of surgeons have that trait. I wonder if I am guilty of it as well. Something to examine in the mirror in our future endeavors.

Re: A Life-Saving Checklist (2007)

#17

I have a dumbass problem where after I've driven away from home I can't remember if I locked the front door or closed the garage door so I turn around and go back home to check. I've managed to fix this by saying out loud, "door locked - check" and "garage door down - check" when I've done it. Now I just need a checklist to remind me to do a checklist.

It's checklists all the way down.

Re: A Life-Saving Checklist (2007)

#18
post #11

"The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. . . ." Indeed, benefits of checklists can be huge. this reminds me of a US Army study I read about some time ago which examined the effects of sleep deprivation and stress in demanding environments. What they found…

I've always hated my bad memory, and I learned a long while ago that simply trying to remember through sheer force of concentration did not work. It was as hopeless as praying for rain. Only external memory tools and strategies planned in advance can solve it for me.

I have to build a system to keep me from forgetting, because if I leave it up to my future self alone then he will forget 100% of the time.

Re: A Life-Saving Checklist (2007)

#19
post #12

In his book, The Checklist Manifesto, Gawande reports that at the end of a big checklist pilot project for the World Health Organization (IIRC), participating surgeons were surveyed. • One of the survey questions was, in essence: Would the use of checklists improve your surgical practice? Most of the surgeons responded no. This was consistent with the resistance that Gawande encountered: I don't need no stinking chec…

Wow. That's such a supreme indicator of overconfidence--the belief that I and I alone am so competent that I don't need safeguards. I would not have hoped that a high percentage of surgeons have that trait. I wonder if I am guilty of it as well. Something to examine in the mirror in our future endeavors.

I like to use the term Dunning-Kruger instead of over-confidence or hubris to describe it. Everyone thinks they demonstrate above average skill. During the 2007-2009 financial crisis every single financial services firm justified their executive bonuses by claiming their personnel were above average. Very few car drivers consider themselves below average.

Before germ theory gained acceptance or was even understood, physicians and surgeons considered themselves above hand washing as a gentleman's hands are always clean. Ignaz Semmelweis discovered that washing hands and tools in chlorine solution reduced childbirth deaths. But he was unable to convince others.

In modern times doctors have answered a survey on the effect of pharmaceutical representatives visit. The overwhelming majority responded that they are not swayed by drug saleswomen, but that other docs are susceptible to choosing a prescription drug because of salesmanship instead of only efficacy & risk.

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