Checklists: Agents of Better Outcomes and Cultural Shifts

Right before I left for Washington, DC, I finished Dr. Atul Gawande’s last book, The Checklist Manifesto.  Unlike his previous books, this was not a collection of essays but rather was an account of Dr. Gawande’s exploration into the idea of using a checklist to reduce disastrous outcomes that can be avoided if certain simple steps are not overlooked.  Dr. Gawande looks to many other professions, especially airplane piloting, where checklists have found great success and advocates for their use in all professions, including his own.

In addition to making operations going smoothly, Dr. Gawande discusses how checklists have facilitated communication, particularly in the operating room where he works.  This idea struck an even greater chord with me.  A simple thing like a checklist was not only improving end results but it was doing so by introducing a cultural shift.  For the longest time, I have recognized cultural shifts to be very difficult.  Cultures can be extra-resistant when it seems that shifts are being mandated and seem to enjoy being the subject of more random forces.  However, by creating the checklist and making nurses responsible for them, Dr. Gawande had been able to see shifts in the dynamics between surgeons and nurses where there was once a culture of silence.  It would seem that culture will change in small doses and that gives me hope for areas where there really needs to be changes in professional culture such as medical professional culture.

I also enjoyed Dr. Gawande’s discussion as to why some doctors where resistant to the idea of a checklist, itself.  In short, it can be summarized into vanity.  Checklists do not seem necessary to people who have years of training and yet, Dr. Gawande argues that checklists allow doctors to get the no-brainers out of the way so that energy can be focused onto the higher level thinking.  I am all for something that lets me do that.  And to be perfectly honest, “brilliant” TV doctors such as House could prevent and maybe even solve cases quicker if they kept checklists for procedures.  Don’t get me wrong, I love the show (or at least the first three seasons) but the show represents a lot of what is inefficient and counterproductive in medicine today.