NPR covers a good bit of the HF field in one conversation with two doctors

All Things Considered interviewed Dr. Peter Pronovost this weekend about the checklist he developed for doctors and nurses in busy hospitals. On a topical level, this illuminated the working memory demands of hospital work and statistics on how easy it is to err.

As an example, a task analysis revealed almost two hundred steps medical professionals do per day to keep the typical patient alive and well. On average, there was a 1% error rate, which equates to about two errors per day, per patient.

Pronovost introduced checklists for each type of interaction, which resulted in Michigan hospitals going from 30% chance of infection (typical across the US) to almost 0% for a particular procedure.

Could something as simple as a checklist be the answer? No, because this intervention wasn’t “just” a checklist.

Whether trained in these areas or not, the doctors interviewed had to understand:

Team training: Nurses are trained not to question doctors, even if they are making a mistake. Solution: Pronovost brought both groups together and told them to expect the nurses to correct the doctors. (Author note: I’d be interested to see how long that works.)

Social interaction: In an ambigous situation, people are less likely to interfere (e.g., the doctor didn’t wash his or her hands, but the nurse saw them washed for the previous patient and thinks “It’s probably still ok.” Checklist solution: eliminate ambiguity through the list.

Effects of expertise: As people become familiar with a task, they may skip steps, especially steps that haven’t shown their usefulness. (e.g., if skipping a certain step never seems to have resulted in an infection, it seems harmless to skip it). Checklist solution: enforce steps for all levels of experience.

Decision making: People tend to use heuristics when in a time-sensitive or fatigued state. Checklist solution: remove the “cookbook” memory demands of medicine, leaving resources free for the creative and important decisions.

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About Anne McLaughlin

Associate Professor, Department of Psychology, North Carolina State University, Raleigh, NC

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5 Responses to NPR covers a good bit of the HF field in one conversation with two doctors

  1. Richard Pak December 10, 2007 at 10:26 am #

    Nice find…

  2. Anne McLaughlin December 10, 2007 at 10:51 am #

    In the interview they point out that if there were a drug that saved hospitals hundreds of millions of dollars and reduced infection by a large percentage (as these checklists have done), it would be REQUIRED and in the hands of every medical professional as soon as possible.

    And yet, they have had great difficulty getting their checklists into other states.

    I think it speaks to how we think of solutions: a drug is a solution you can understand and see. A checklist makes it seem as though the worker could do the task without if he or she were just “careful” and knew what to do. It also indicates that doctors and nurses are fallible (and WILL make mistakes) when each one thinks they aren’t making any errors…

  3. Anne McLaughlin December 11, 2007 at 1:00 pm #

    Also, credit to Tom Drewes for bringing the NPR bit to my attention.

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