The Checklist Manifiesto: The Test

Following the schedule of our Reading Calendar

After studying in detail the aviation industry approach to checklist development, Atul Gawande’s team work hard to redo their safe surgery checklist following the principles they had learned:

1. Not to include too many things so that it may be practical

2. Not to forget really important thinks so that it may be useful

3. To foster team building, to help react against the unexpected.

Big parts of their initial failed checklist are removed after iterative modifications and surgery simulations using the proposed checklists.

When a final consensus is reached, the result is a 19 point checklist divided in 3 stopping points: before anesthesia, before incision and before taking the patient out of the operations theater. A pilot study is devised to check its utility analyzing surgery complication rates in 8 hospitals around the world before and after the introduction of the checklist use. The hospitals are selected in such a way that reflect a broad spectrum ranging from affluent and high technology centers in rich countries to poor rural hospitals in third world countries.

Further changes in the checklists have to be added to meet local particularities of each hospital. The nurses are given the authority to conduct the checklist routine.

After 3 months, the results come and they are shocking:

the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after introduction of the checklist. Deaths fell 47 percent. (…) Using the checklist had spared more than 150 people from harm- and 27 of them from death

Three months later this findings are published in The New England Journal of Medicine as a rapid-release article. Public health authorities around the world became interested in applying the procedure.

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