Atul Gawande is a surgeon specializing in endocrine oncology, a teacher at Harvard Medical School, and a writer for the New Yorker magazine. But he found time a while back to take on a WHO committee that was trying to find simple, inexpensive ways to improve the outcome of surgery in developing countries. He reports on this project in his new book, The Checklist Manifesto: How to Get Things Right.
That's a pretty big assignment but hospitals around the world achieved startling results. In the eight hospitals taking part in the initial study major complications for surgical patients fell by 36 percent, deaths fell 47 percent. The results were so stunning that University of Washington Medical Center recommended that this process be used in all Washington State hospitals, and it is.
The magic procedure? A checklist. A short checklist to be gone over in the operating room before the patient is given anesthesia, before making the first incision, and before finishing the operation.
It wasn't easy to create this checklist. Gawande spent a good deal of time looking at the checklists used by people building high-rise buildings and by aircraft pilots. He interviewed the man at Boeing in charge of The Checklist Factory, where checklists for all Boeing aircraft are created, tested, polished, retested, and finally issued to owners of Boeing planes. And after similarly testing and polishing the surgery checklist it was used in hospitals ranging from an isolated facility in Tanzania which is inaccessible by road for part of the year, a hospital in New Delhi with an average of 3 million patients a year (and seven anesthetists), and the London hospital where Prince William was born.
Anyone who has followed Gawande's articles in the New Yorkerknows how clear and lively his writing is and when he has something to as exciting as this checklist project to talk about he excels. Highly recommended.