Poor use of checklists means that people may be dying unnecessarily. A cadre of researchers is . . . finding a variety of factors that can influence a checklist's success or failure, ranging from the attitudes of staff to the ways that administrators introduce the tool. The research is part of the growing field of implementation science, which examines why some innovations that work wonderfully in experimental trials tend to fall flat in the real world. The results could help to improve the introduction of other evidence-based programmes, in medicine and beyond.
Totally predictable, as Captain Sullenberger noted over four years ago:
A checklist alone is not sufficient. What makes it effective are the attitude, behavior and teamwork that go along with the use of it.
Checklists are a tool, not a solution. Below, I reference the only article I have ever read in the healthcare literature that explains the need for checklists to be defined by the frontline workers at each local environment and applied to a specific process as well as needing to be adaptable, not static:
ReplyDeletehttp://www.sjtrem.com/content/19/1/53
This is another example of the serious misinterpretation of safety science prevalent in healthcare.
As one who experienced a 'conversion' into the whole idea of care quality and patient safety late into my (now retired) career, I have to say that you can't do this piecemeal. This occurred for me in the late '90's and early 2000's when the science was not as well developed, and I was skeptical at first, as I'm sure many, many physicians are. It took months of exposure to an enlightened and articulate anesthesiologist, leader of our Performance Improvement Council, and a committed support staff, for me to finally and completely 'get it.'
ReplyDeleteYou simply cannot, CANNOT, introduce this as just another thing to do for staff and physicians, and a few training meetings won't do it either. You must have one or more strong in house champions who know what they are doing. I know Paul has preached this but I am repeating it as a former heathen, so to speak.
You know that some doctors think that all the checklists makes everything perfect. :)
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