Checklists and Surgery

 

Steve Bather commented on a post from the other day about simplification. He reminded me of a story I had heard a couple of years ago about Dr. Atul Gwande, a NY heart surgeon who has been successfully implementing a checklist into the operating room. The NPR story talked about some research he had done at the Harvard Medical School. I found the article very interesting, I think you will too.

"Our great struggle in medicine these days is not just with ignorance and uncertainty," Gawande says. "It's also with complexity: how much you have to make sure you have in your head and think about. There are a thousand ways things can go wrong."

Because doctors are human (just like everyone else), they sometimes miss things. So Gawande looked at other fields that deal with complex circumstances and visited, among others, Boeing to see how they make things work. He cites the "pilot's checklist" as a good example of how other complex tasks are completed outside of medicine.

Unlike a pilot, there is no checklist in surgery, just the surgeon's experience and intuition that dictates how a procedure is performed. So as an experiment, he brought a two-minute checklist into the operating room of eight hospitals—after having worked with a team of folks that included Boeing to show them how to put the checklist together.

How did it work?

"We get better results," said Gawande. "Massively better results."

"We caught basic mistakes and some of the stupid stuff," Gawande reports. "We also found that good teamwork required certain things that we missed very frequently."

Something as simple as making sure that everyone in the operating room knew each other by name turned out to be incredibly valuable.  Isn’t it interesting how similar some of these issues sound to the work management issues project teams face every day?

Not unlike some project managers I have met, many of the surgeons weren’t originally too keen on operating with a checklist.  However, when all was said and done, 80% of the surgeons saw the value of the checklist.  And, although 20% said they didn’t need the checklist, 94% said that if they were going to have surgery they would want their surgeon to be using a checklist.

I realize that heart surgery and project-based work don’t have a lot in common.  That said, the surgeon could learn a few things from project managers about how to create a sound work management (surgery management) methodology.  Project managers could also learn from this study. "We caught basic mistakes and some of the stupid stuff," Gawande reports. "We also found that good teamwork required certain things that we missed very frequently."

Despite all the evidence, Gawande wasn’t sure that using a checklist would help save the lives of his patients—after all, he was from Harvard.  However he started using the checklist and says, "I was in that 20%.  I haven’t gotten through a week of surgery where the checklist has not caught a problem."

Like surgery, capturing best practices and formalizing processes are critical for success.  Like the surgeon’s checklist, the right project management tools can help.  Fortunately, there is a lot we can learn from Dr. Gawande’s study.  As well as what a heart surgeon could learn from a project manager.

If you were going into surgery, would you feel more comfortable if you knew the operating team was using a checklist to make sure nothing got missed?  I think I would.