I am looking forward to attending the SMACC 2015 conference this week where I am going to learn about how we can apply the experience of other industries to the complex critical care environment in which many of us work.
Today I have quoted from Atul Gawande’s recent book to draw out his reflections on getting things right. Here is a powerful thought for the day about healthcare in 2015:
The Checklist Manifesto
Gawande A (2010):
“We are besieged by simple problems. In medicine, these are the failures to don a mask when putting in a central line or to recall that one of the ten causes of cardiac arrest is a potassium overdose. In legal practice, these are the failures to remember all the critical avenues of a defence in a tax fraud case or simply the various court deadlines. In police work, these are the failures to conduct an eyewitness lineup properly, forgetting to tell the witness that the perpertrator of the crime may not be in the lineup, for instance, or having someone present who know which one the suspect is.
Checklists can provice protection against such elementary errors…
He (Joe Salvia, an Engineer) pulled out the construction plans for a four hundred foot tall skyscraper he was currently building and flipped the table of contents to show me… All the separate contributions had to be included. Yet they also had to fit together somehow so as to make sense as a whole. And then they had to be executed precisely and in co-ordination…
For most of modern history, he explained, the dominant way people put up buildings was by going out and hiring Master Builders who designed them, engineered them, and oversaw contruction from start to finish, portico to plumbing… But by the middle of the 20th centrury Master Builders were dead and gone. The variety and sophistication of advancements in every stage of the construction process had overwhelmed the abilities of any individual to master them…
Yet we in medicine continue to exist in a system created the Master Builder erea – a system in which a lone Master Physcian with a prescription pad, an operating room and a few people to follow his lead plans and executes the entirety of care for a patient, from diagnosis through treatment. We’ve been slow to adapt to the reality that, for example, a third of patients have at least ten specialist physicians actively involved in their care by their last year of life…
Architects, engineers and builders were forced long ago – going back to early part of the last century – to confront the fact that the Master Builder model no longer worked. So they abandoned it. They found a different way to make sure they get things right.”
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