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

Cheryl Clark, for HealthLeaders Media, February 3, 2011

"We value physician autonomy, which works well when there are just two full time equivalents providing care, but when we have 19.5 FTEs trying to make things work, it becomes a problem."

His three values that he thinks providers should embrace are these:

1. Humility. "Recognize that no matter how smart we are, how well-trained, no matter how much experience, you will fail. You won't have it all together every time, every day.

2. Discipline. The way you overcome failure is by doing the same thing the same way, every time, over and over. Appreciation of that second value, he says "could save us."

3. Teamwork. "The belief that other people, no matter their station or specialty or background, can save you from an error."

Gawande is not slowing down. Now, he's busy developing more checklists for various procedures in neurosurgery, and then there's another project for checklists when surgeries start to go wrong. Anaphylactic allergic reactions, cardiac arrest, malignant hypothermia, hemorrhage are a just a few of the things that can and do go wrong.

He's also working on a checklist to help physicians and other care providers know how to discuss end-of-life care with terminally ill patients, perhaps the one topic physicians are most likely to avoid having, even when it matters most.

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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.