The bad news is how frequently mistakes occur in operating rooms, including even extreme, if relatively rare, errors such as removing the wrong body part or leaving something, such as a medical sponge, in the patient. Noted surgeon and writer for The New Yorker, Atul Gawande, explores why such preventable mistakes occur and what can be done in his thought-provoking book, The Checklist Manifesto. The good news is that an intervention, which Gawande created with a team supported by the World Health Organization, has dramatically reduced the number of errors in operating rooms that have adopted it. More bad news, however, is how resistant many surgeons and others are to using the intervention.
The tool Gawande helped develop is a safe surgery checklist, which briefly outlines a minimum of absolutely critical steps to take before anesthesia, just before incision, and before the patient is taken from the operating room. The checklist lays out “pause points” for communication among the surgical team to help ensure readiness for potential complications and to confirm key steps—that can all-too-easily be overlooked—have been completed.
Gawande suggests that mistakes commonly occur, in part, because of the sheer complexity of the work at hand combined with the trend for professionals to become ever more specialized in one area of expertise. Each person involved with a surgery has tremendous expertise in their specialty, but no one individual is an expert in everything that needs to go right in an operation. And tremendous complexity and stress make it difficult to rely on one’s memory to carry out all necessary procedures.
Key reasons the safe surgery checklist has not been adopted more widely may be due to a kind of hero worship—some surgeons feel offended at the idea of using such a tool (superheroes don’t like to admit they make mistakes). Yet checklists are employed extensively by professionals in fields where the likelihood of making mistakes has been acknowledged, such as aviation and building construction. Not only do these fields make extensive use of checklists, but when mistakes do occur, they are likely to be studied and, if appropriate, the relevant checklists revised or new ones added. The checklist—if there is willingness to use it—can be a tool to help learn from mistakes and consider how processes can be improved.
The point of a checklist for Gawande is not to stifle creativity or initiative, but to make sure the fundamentals are in place—crucial steps that are easily overlooked. In a way, using a checklist is a simple idea — in fact Gawande encourages simplicity and focus when creating them (here is the one-page WHO safe surgery checklist). But that doesn’t make the idea simplistic—as Jonathan Ive, the famous head of industrial design at Apple said when introducing a product, “[T]here is a profound and enduring beauty in simplicity; in clarity, in efficiency.”
I will have more to say on implications of the checklist notion for leadership, decision-making, and high-performing teams. For now here are a few questions to reflect on:
- Consider an area in which you feel you have expertise. How do you react if someone points out an error? (Be honest!)
- Have you worked on a team where it didn’t seem that everyone was on the same page and working from the same action plan? What did the team do about that?
- What can a team—or an individual, for that matter—put in place to make sure to learn from mistakes?