Atul Gawande and the power of checklists

Atul Gawande informs us of the power of checklists.

As readers of this blog know, my mother spent more than a month in the hospital this spring due to congestive heart failure.

My brothers Mike and Jon spent hundreds of hours at the hospital, advocating for Mom and trying to make sure that she got the best treatment possible.

One of the major challenges they found was that information about Mom’s pre-exsiting conditions and current medical status rarely transferred between the heart, kidney and other specialists assigned to her care.  The lack of information transfer also occurred with nurses working on different shifts with Mom.

In The Checklist Manifesto, Stanford classmate Atul Gawande, who has gone on to Olympian heights of a Harvard professorship, a staff position at The New Yorker and a MacArthur grant, says this phenomenon is not limited to Mom, but rather is a function of the hyperspecialized direction in which medicine has evolved.

A key component in improving communication and saving lives: a checklist.

In the book, Gawande talks about his own initial skepticism toward checklists as well as the difficulty he had implementing a precise, swift and effective one for surgery in his own operating room as well as in countries throughout the world through his invovement in the WHO’s Safe Surgery Saves Lives program.

He also writes about how he, for a time, saw checklists in professions ranging from restaurants to aviation to building construction.  Through learning about their application of checklists, Gawande came to belive in the utiliy and power of this seemingly unremarkable mechanism.

Gawande also peppers the book with his own operating experiences, ending the book on a story about a time that an error he made could have had fatal consequences, but did not, thanks to the use of a checklist to introduce the participating staff members and a nurse’s thoughtful response to Gawande’s mentioning he had not done the operation before with a specific amount of blood.

The Checklist Manifesto also has a fascinating chapter about the famed airplane crash on the Hudson in which Captain “Sully” Sullenberger and his crew used checklists to save the 155 passengers who easily could have perished in the freezing water.

Gawande does not offer checklists as a panacea and is quick to write about getting thrown out of operating rooms throughout the world, but the power of his central point is impressive.

I’m going to wrap up this post now, and will certainly get checklists going for the various activities I do with interns from now in addition to using what I’ve learned when thinking about Mom’s care going forward. 

I’ll keep you posted on the results.


2 responses to “Atul Gawande and the power of checklists

  1. Thanks Jeff. I really needed this post. Checklist. Makes sense. For the past year both of Matt’s parents have been in and out of ICU, hosp, and skilled care, with little info going from place to place, and state to state. It is like starting over every time.

    • jeffkellylowenstein3

      Thanks, Lannae, for your note. I’m sorry to hear about Matt’s parents’ health challenges and hear you completely about starting over every time.

      Hang in there, and thanks again for commenting.


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