Syndicom

Surgical Checklists – A Panacea or Just A Way to Get People Talking?

There is much talk these days about the recent yearlong study revealing that surgeons following a 19-step checklist in the operating room can reduce the rate of deaths and complications by one-third. But what does the checklist mean for our current understanding of communication and collaboration in the clinic?

The yearlong, eight-nation project lead by Atul Gawande, among others was recently published in the New England Journal of Medicine. Ceci Connolly in her Washington Post article said, “according to the checklist, before an operation begins, the team members introduce themselves, review the patient’s name and the procedure being performed. They discuss allergies, confirm that all equipment has been sterilized and necessary antibiotics administered, and assess potential problems such as blood loss.” Gawande points out that a checklist seems like a no-brainer, but the benefit is significant and experts estimate between $15 billion and $25 billion a year can be saved.

While some may think this is a no-brainer, E-patient Dave supports the use of checklists in reducing harm and encourages patients to speak up and demand they (surgeons) put patients first by using the checklist. But as mentioned in his article, concerns for adoption include, unfortunately, “it’s too hard to change culture” and “I don’t wanna do it different.” Gawande in his New Yorker article also alludes to the challenges of changing the traditional culture of medicine, “with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity—the right stuff, again. Checklists and standard operating procedures feel like exactly the opposite, and that’s what rankles many people.”

On a different note, KevinMD asks whether a set of irritating instructions on a laminated list really halve death rates. His post generated comments about the ludicrous idea that we need a checklist to remind people to talk with each other. Is that what this checklist is all about – enhancing collaboration?

Certainly, checklists are productive. Could checklists help us redefine a new mission and role for ourselves? Are they setting an agenda for a very different healthcare system that fosters collaboration, communication, and commitment all the while remembering the unique circumstances of individuals’ life and health? Checklists may get people talking but for patients, surgeons and medical practitioners to be in harmony, we must think in different terms of collaboration so that our vocabulary for expressing these thoughts grows and so that collaboration becomes the norm and not the exception (or reminder) during surgery. I welcome your comments!

With thanks to Dan O’Leary for their photography.

Great things emerge when we collaborate!

Carey Candrian