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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