Checklists cut surgery deaths by 50% in the Netherlands

Lean thinkers are advocates of the use of standards. Standards are the currently best known way of handling a task. A standards eliminates the need to think while executing the task, so attention can be paid to improvement work.

Professionals such as lawyers, doctors, accountants, who spend years studying to qualify for their profession, often resent standards. They claim standards cannot be applied to their intellectual work.

The typical example of how standards can be applied for intellectual professions are the checklists a pilot uses when preparing for a flight. Now there is another great example: the use of checklists in surgery.

Using an exhaustive hospital checklist prevents errors and cuts the risk of death nearly in half for patients who come in for surgery, researchers reported in 2010.The system also reduced the number of complications by one-third, they reported in the New England Journal of Medicine. The study adds to growing evidence that checklists can save trouble, lives and money in hospitals.

The study in the New England Journal of Medicine involved 11 hospitals in the Netherlands, six of which adopted a system that required everyone caring for a surgery patient to mark whether they had checked a key factor in the process. The rate of complications at the hospitals using checklists dropped by 31 per cent per patient and the death rate fell from 1.5 per cent to 0.8 per cent. The rates were unchanged at the five control hospitals.

"The Checklist Manifesto: How to Get Things Right" is a book by Atul Gawande on this topic. Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don't know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it's just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality.

I'm excited about the progression medicine is making and believe we can apply the learning in our own professional environment.


Resources:
- Video interview with Atul Gawande.
- Research findings from New England Journal of Medicine