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Gawande on Checklists: Why Don't Hospitals Use Them?

Cheryl Clark, for HealthLeaders Media, February 3, 2011

He  flies around the country a lot giving inspirational talks to leaders of systems trying to improve, even while still pushing the research envelope trying to find better ways to prevent mistakes, improve care and lower costs.

These days, when he's not in the operating room removing endocrine tumors, Gawande works on checklists. "It's a gamble. But I want to do something that might make a difference," he said.

In "The Checklist Manifesto," he describes his work with the World Health Organization's project to reduce surgical errors through the use of a 19-point checklist, which could be adopted in poor hospitals in developing countries as well as wealthy hospitals in the developed world.

Today, only 25% of American hospitals have adopted surgical checklists, Gawande told this Scripps audience. For whatever reason, he says, to get surgeons to make such a change in their approach "has been immensely hard."

For starters, the most controversial idea for teams to accept is perhaps the simplest item in the checklist. Require all team members say their names prior to the launch of the procedure.

"This has been one of the most important things that help people feel comfortable speaking up" if they're unsure or unclear, for example, that this is the right patient, right site, right procedure.

"It acknowledges that you're part of a team and are allowed to speak."

Gawande says that there has been resistance to accepting checklists at another level. "The concept has forced us rethink what it means to be great at what we do. And I hadn't grasped this until I saw it recur over and over again. There's a set of values in the idea of a checklist, and they're in distinct conflict with some of the values we have in medicine.

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3 comments on "Gawande on Checklists: Why Don't Hospitals Use Them?"


Robert Finney, Ph.D. (4/8/2011 at 12:15 PM)
Original investigations on Kaiser Permanente fraud, waste, abuse, and mismanagement are posted on YouTube at http://www.youtube.com/watch?v=v0h7tUymj2Y and www.hmohardball.com. Dr. Gawande promotes Kaiser's scams. Robert D. Finney, Ph.D.

Fernando Petry (2/4/2011 at 6:57 AM)
I wholeheartedly agree with Gawande. Currently working on checklist for ICU rounds due to the complexity of IV's, fluids, meds, labs that are forgotten on a daily basis. To acheive six sigma improvement in healthcare we should use checklists. Only our arrogance and lack of humility prevent us from saving lifes.

Tom Gable (2/3/2011 at 3:19 PM)
Nice piece! And I recommend his book, the Checklist Manifesto. It's a quick read and can help any firm [INVALID] technology, medical, scientific and even PR (!) [INVALID] better organize for results and make sure you take the right steps to get there.