I’m curious about the process of actually using these checklists. Is there ink and paper involved, with someone physically drawing a check in a box? Does one person do the thing and a different person check the box? (Sounds like that’s the case with doctors and nurses at least.) Or is it just, like, “here’s a list, follow the list”? Presumably it differs between use cases and organizations, but are there guidelines for what processes to use when?
I’m imagining failure modes where someone has an internal experience like… “okay, done step 1, and now step 2 is right over here, might as well do that and go back and check them both. Wait, hm, did I do step 1? Pretty sure, yeah.” And then absentmindedness eventually leads to checking step 1 despite not having done it. Presumably much less likely than abesentmindedly forgetting step 1 without a checklist, but I’m wondering how necessary and/or common it is to guard against that kind of thing.
This in fact varies a lot! Whether it’s ink or paper versus a computer screen depends on what a given hospital uses for charting; I’ve done both ways. A lot of major procedure checklists (the central line one, surgical checklists) are filled out by a separate person whose job is basically just observing and documenting (and, of course, calling people out for skipping items!) Whereas checklists for smaller, more routine tasks are done by a single person in a less formal way – e.g. the Five Rights of med administration, where you double-check at the bedside, against the chart, that you have the right patient, right med, right dose, right time, and right route of administration.
Gawande does make a distinction in the book between, basically, whether you read off a checklist item, do it (or have someone else do it), and then check it off, versus whether you carry out the task and then review the checklist to make sure you did everything.
I do think it helps on the absentmindedness front that medical tasks are very concrete and...pretty memorable? Even if I was half zoned out at the time, it’s a lot easier for me to remember whether I cleaned a patient’s pubic area with iodine than “wait did I cc person X on that email?” And, of course, in that case the effects are also visible, because now the patient’s pubic area is yellow! Items like checking a patient’s bracelet and the name of a med are, in a lot of modern hospitals, automated via using a bar code scanner linked to the patient’s digital chart, leaving a lot less room for error.
I’m curious about the process of actually using these checklists. Is there ink and paper involved, with someone physically drawing a check in a box? Does one person do the thing and a different person check the box? (Sounds like that’s the case with doctors and nurses at least.) Or is it just, like, “here’s a list, follow the list”? Presumably it differs between use cases and organizations, but are there guidelines for what processes to use when?
I’m imagining failure modes where someone has an internal experience like… “okay, done step 1, and now step 2 is right over here, might as well do that and go back and check them both. Wait, hm, did I do step 1? Pretty sure, yeah.” And then absentmindedness eventually leads to checking step 1 despite not having done it. Presumably much less likely than abesentmindedly forgetting step 1 without a checklist, but I’m wondering how necessary and/or common it is to guard against that kind of thing.
This in fact varies a lot! Whether it’s ink or paper versus a computer screen depends on what a given hospital uses for charting; I’ve done both ways. A lot of major procedure checklists (the central line one, surgical checklists) are filled out by a separate person whose job is basically just observing and documenting (and, of course, calling people out for skipping items!) Whereas checklists for smaller, more routine tasks are done by a single person in a less formal way – e.g. the Five Rights of med administration, where you double-check at the bedside, against the chart, that you have the right patient, right med, right dose, right time, and right route of administration.
Gawande does make a distinction in the book between, basically, whether you read off a checklist item, do it (or have someone else do it), and then check it off, versus whether you carry out the task and then review the checklist to make sure you did everything.
I do think it helps on the absentmindedness front that medical tasks are very concrete and...pretty memorable? Even if I was half zoned out at the time, it’s a lot easier for me to remember whether I cleaned a patient’s pubic area with iodine than “wait did I cc person X on that email?” And, of course, in that case the effects are also visible, because now the patient’s pubic area is yellow! Items like checking a patient’s bracelet and the name of a med are, in a lot of modern hospitals, automated via using a bar code scanner linked to the patient’s digital chart, leaving a lot less room for error.