Flutterby™! : Checklists 2007-12-16 20:08:40.072655+00

Checklists

2007-12-16 20:08:40.072655+00 by Dan Lyke 7 comments

A bunch of folks have been linking to this New Yorker article about how checklists are saving lives in ICUs and medicine in general, I thought the timing was interesting, because I saw that at the same time that I saw a bunch of mistakes at Rhode Island Hospital. What makes an institution, be that a business or another organization, more valuable than the contributions of the individuals in it, is the sets of procedures and documentation and the culture builds up around those. That's also what makes it less valuable.

True for almost any business: If you can work out almost possibility, flow chart it, policy it and procedure it, make it a process, almost any moron can follow the procedures and do a passable job at 'X'. What makes a great entity is when you have smart people that follow those procedures -most- of the time, very well. And know what to do when there needs to be an exception.

To keep smart people doing 'X' when it can be handed processed to death and done by mundane robots you have to provide perks beyond money. Working with smart management, other good people, a feeling that what yuo do matters and is appreciated, peer respect and respect for your peers...

Working in heavily repetitive health care (pharmacy) as I do, one learns to develop a checklist mentality for both safety and efficiency, but that in itself can become mind numbing as the sheer volume at peak hours leaves you with little time to think outside the checklist, which as Dan mentions, yields a more productive (ie., more valuable to the owner of the process) but less valuable (ie., the skill of performing the production is devalued) process.

As we inch toward a socialized model for health care, expect to see more emphasis on efficiency yielding better patient outcomes. These are, of course, thinly disguised ways of cutting costs.

So if we want the best service from our pharmacist, that midnight to 8AM shift is the one to visit on?

What I also find interesting is the resistance to procedural change. When faced with "this process isn't working, we might be able to maintain the current benefits if we do X and we'll get over this hurdle", the "but what if that causes Y to disappear" outcry is really strong. Momentum hurts.

#Comment Re: made: 2007-12-18 02:16:23.759007+00 by: topspin [edit history]

I dunno.... those all night pharmacist's are sketchy and they probably just threw out some meth head or hydro junkie and may be a bit on edge when you see them. ;-)

Procedure change SOUNDS nice and helpful, but it's easily argued that errors are more likely during transitions/changes in procedures.... so who wants to volunteer to be the patient during those transition times? Who wants to be the patient in ICU while the staff is uncomfortable with the new procedures and tentatively consulting the new procedure checklist while you are experiencing the most harrowing hours of your life? I'll pass.

If the job could and would "let up" and allow the staff to reasonably deal with the stress of new procedures and ways of doing things, that would be wonderful, but the nature of the ICU is NORMALLY "life and death" stressful situations with the very real potential for catastrophic errors or omissions, so reluctance to the additional stress of procedure change seems normal.

Yeah, I was just talking about procedure change for a software development process that seems to be failing. The risk/reward ratio is different there.

Sounds like I may have to haunt a pharmacy in the wee hours just for the entertainment value?

Our store's safe, for various reasons, but there's been a rash of gun to the head, get me the oxy's now situations in town, including the Sig. Mtn. Road CVS (next to Bi-Lo) being robbed twice in the past 4 months by guys with handguns and Riverview once.

We just get shopping cart ladies who've been to the ER falling asleep in our waiting area for 3 or 4 hours and drunk guys fighting in the parking lot over the beer bottles they just stole and a guy who felt the need to push his girlfriend into the shelves because she asked me for some butterfly band-aids for the nice eye gash he'd received from someone earlier. My co-worker Mortez had the winning line on that one: "Well, he finally found a fight he could win."

Maybe I'll get all O. Henry one day and use this stuff for stories.... with a suitable southern pseudonym like R. Traylor.

I can't for the life of me understand how one could perform a job without a punchlist. Sure, one needs to adjust a punchlist for unique circumstances but the punchlist still has to be there. You just don't have a process without one.