Lists could save the world
I am a list-maker. In our household, we have two multi-itemed lists taped on the back door going into the garage so they will not be missed. One is titled "Groceries" and today it includes "soy milk," "mangos" and "dog bones." The other announces "Weekend Yard Work" and divides who does what. My husband's column contains notably more items — I like it that way.
I have a thoughtfully categorized list taped onto the back page of my carry-around calendar, also, which prioritizes daily tasks. And, yes, I occasionally put something already completed on my list just to have the satisfaction of crossing it off as accomplished. In checklist lingo, that's a "do confirm" action.
I am unapologetic about my penchant for making lists. Lists may change the world. I guarantee you too will become a believer after you read Atul Gawande's "The Checklist Manifesto: How to Get Things Right."
The author is a physician, so the book is largely a series of well-written stories about the effective (life-saving) use of checklists in surgery settings and clinics. One list starts with the simple reminder to "wash hands with soap." When that type of checklist was used in one hospital "the proportion of people not receiving appropriate care" dropped from 70 percent to 4 percent, the occurrence of pneumonia fell by a quarter and 21 percent fewer people died" as compared to the preceding year. Let's take time out for a quiet, "wow."
A riveting story launches the book. It's about a 200-pound man who got into an altercation at a Halloween night costume party. The stab wound in his abdomen seemed relatively minor and the emergency room triage team did not think he was in immediate peril. Had there been a checklist requiring them to ask "type of weapon" causing the injury (in this situation it was a bayonet which results in a much deeper and more life-threatening wound to the intestines) their treatment decisions would have been quite different. (The guy survived — barely.)
I want any hospital I'm in to use checklists (93 percent of physicians queried feel the same way).
And checklists are not just lowering infection rates and saving lives in medical settings; they're used in remarkable ways on construction sites and are starting to play a role in investment banking decisions. And, of course, checklists are used in airplane cockpits.
Recall the "miracle on the Hudson," where a US Airways jet was struck by a huge flock of Canadian geese immediately after take-off. The plane immediately lost both engines and was forced to land in the icy Hudson River.
That pilot, Sully Sullenberger, and his first officer, Jeffrey Skiles, were highly experienced. The entire crew had a combined 150 years of flight experience and no record of accidents. It was a routine flight. It would have been easy for them to begin the flight without attending fully to the required checklists. But before they even started the engines, they ran through their checklists as a team —with practiced discipline. And when the incident occurred — what did they refer to immediately. Yes, it was their checklists.
Sharon Johnson is an associate professor in health and human sciences at Oregon State University and on the faculty of the OSU Extension. E-mail her at email@example.com or call 776-7371, Ext. 210.