The Checklist Manifesto – How Medicine Was Saved From “The Experts”

We all are experts. Professionals with highly specialized skill sets that make us the masters of our fields and interests. We take pride in knowing that we are good at what we do and that we are too advanced to make trivial mistakes that the “common” people make.  We are simply too smart to do that, too “experienced”.

News flash though, we are also human. And humans are known to make mistakes. As J.R.R. Tolkien put it: “He made a small but grave oversight, as most small oversights are”

We as the experts love to believe in our inability to make mistakes and depending on your profession these mistakes can be a small annoyance or in the case of medical practitioners a grave and lethal mistake. A recent study by the John Hopkins Safety Experts found that over 250,000 deaths in the US are caused by preventable medical errors. These errors can be anything from major things like the wrong diagnosis to small minor issues such as surgeons forgetting to wash their hands before a surgery. Now, none of these surgeons have to be incompetent in any way for these mistakes to happen, they just need to be too busy to notice something. Which when one considers the availability of over 4000 medical procedures and 6000+ medicines available to prescribe is not that inconceivable.

 

Now, this is a dentistry related blog, so let’s take the dentistry relevant approach. Take for example the case of a patient who came in without taking her antibiotics prophylaxis because your team did not remember to send the appropriate reminder. One of two things can happen:

 

  1. Your team finds out AFTER the patients arrive and realizes that you won’t be able to perform the exam
  2. Your team forgets to ask about those antibiotics and you place your patient under an unnecessary risk of infection

 

In situation one:

– You lose money because of the wasted time (missed appointment) and the effort placed in booking the patient

– You may lose the patient for good

– You will look unprofessional for missing such an insignificant thing

 

In situation two

– You risk your patient’s health

– You risk getting sued due to malpractice…

 

Not good…

 

Dr. Atul Help Needed at the UN

 

When the UN reached out to Dr. Gawande to help in reducing mistakes and blunders happening in surgeries around the world and consequently improving their efficiency and cost structure, he did something unique… he actually looked for the source of the problem. For reference Dr. Gawande looked to other critical high-risk industries, that contrary to medical practice, have a very low failure rate due to human error. He looked at industries such as construction and aviation.

 

What Dr. Gawande found was that these industries relied on all the same high tech systems and analysis that medical practitioners do but the main most important difference is that they relied on putting the system together. So take this example:

 

A dentist would have the best imaging systems, and the best reminder systems, and the best equipment along with the latest and most expensive systems the industry has to offer… but what doesn’t she have? A way to make all of this work for her. So that fancy DSLR will sit on a shelf gathering dust until that “High Priority” patient walks in for it to be worth using. Then one day, a “High Priority” case walks in but guess what her team forgot to charge the camera and decide its ok to move forward this one time right? But then it all apparently worked fine, so why use the camera again in the first place, they simply forget about it because they can do their work without it. Until one day someone makes a mistake or a patient thinks they did and there is nothing to prove otherwise!

 

In the industry, we call that an “Oh Shit We Screwed Up” moment.

 

Boeing to the rescue

 

To solve this problem Dr. Atul looked at what made these industries tick, and lo and behold it was the simple checklist. To dig deeper into this Dr. Atul brought in Boeing’s Checklist Expert (Yes those actually exist) Daniel Boorman to help in restructuring these processes in medicine and reduce mistakes. Within a year medical mistakes fell 37% in all countries it was implemented and preventable deaths dropped 47%! With the rest of the mistakes attributed to more systems that needed improving or simply poor or slow adoption of checklists use.

 

Because you know, we are Doctors and we are too smart to need a checklist right? No wrong, very wrong. Because Doctors who managed to get over the idea of using a checklist as being a detriment into a support were humbled by the number of things that used to slip through the cracks that weren’t apparent before.

 

Soooo… How do you implement this revelation

 

Simple, you implement checklists at your practice (or simply use Oryx we handle that for you 😉). Here is how you build a good checklist:

 

  1. Every checklist has a clear pause point

  This is a trigger that tells you that a checklist is needed like a patient booked an appointment, or a patient is coming in now, or the exam itself

  

  1. Points on the checklist should not be teaching you what to do, you know what to do. They should remind you of everything you need to get things done. Like: remind patient to take antibiotics and check if the patient took antibiotics, the list should not specify what antibiotics are to be prescribed to who, just that you verify its done
  2. Speedy, the checklist should not take more than 1 minute to complete
  3. The checklist should be constantly revised, tested and updated according to new data.

 

Oryx

 

Oryx was built with these systems in mind. We have checklists to guide you all through the processes from patient call to the actual exam. We also check off items like reminders, follow-ups, forms… for you through our software.

 

Book a demo to see how https://meetme.so/OryxDentalSoftware

 

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