A year into medical school I cracked open The Checklist Manifesto by Atul Gawande. The book recounts the author’s involvement in the development of the WHO Surgery Safety Checklist and his exploration of checklist implementations throughout various fields. What he found was that medical checklists are remarkably effective, in one study reducing the ten-day line-infection rate from 11% to zero. The underlying question throughout the book is “If people like architects and pilots use checklists to both avoid and minimize errors, then why in the hell aren’t physicians and nurses doing the same?”
And that got me thinking. What if every hospital procedure had an accompanying checklist, from all types of surgeries to administrative operations? Imagine if we optimized every single facet of medical care, from patient admission to discharge, and all intermediary processes, top to bottom.
What I envision is a platform by which a designated individual can develop and deploy a checklist to every staff member in a given hospital. With a few taps, a physician, nurse, or administrator, can create a checklist to help outline the steps to any procedure. A list of complications could be included in which every entry would lead to a subsequent checklist that would help an individual navigate through that particular complication. Linking patient records with checklists would allow for the measurement of checklist efficacy by examining post-procedural infection and mortality rates. Based on this data as well as average time of completion and degrees of compliance, further revisions may be implemented.
But optimizing every procedure is a task far too difficult for any one hospital to take on. And so this platform would require participation by hospitals across the nation (or world). Procedural changes would be delegated to groups of hospitals that would focus solely on perfecting their assigned task. Every hospital would be given the ability to view and implement any checklist being used on the platform at any time. This way, hospitals could test checklists and others would be able to adopt the ones that perform the best. This network of niche optimization groups using version controlled A/B-type tests would greatly decrease the opportunity cost any one hospital would face in deciding whether to systemize their operations because a) everyone’s doing it, b) the changes being asked of them are bearable, c) the majority of the work is being done by the rest of the network and not by them, and, most importantly, d) the prospect of saving lives, time and money are powerful incentives.
Systemization is the only way we’ll ever achieve a healthcare system with near-perfect efficiency and safety. It’s a challenge that’ll take Herculean effort, but a girl can dream.
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