Checklists Alone Won't Change Health Care: The Full Story

Checklist can work, but it's not enough to merely hand doctors a piece of paper, we must respect and acknowledge each member of the care team and measure results.
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Ten years ago at Johns Hopkins, my team began adapting aviation checklists to medicine. In 2006 we published a landmark paper in the New England Journal of Medicine detailing how we used checklists to nearly eliminate infections, not just in one hospital, but throughout the entire state of Michigan. We are now spreading that program to every hospital in the United States. Today, I am heartened by the growing use of checklists in hospitals, and flattered to see that leading medical journalists, such as Atul Gawande, are supporting our work and helping us spread the word.

And who wouldn't love the story: a checklist, a simple inexpensive tool, eliminates infections and save lives? Though this makes compelling journalism, it does not make good science. Checklists, though important, are only part of the Michigan story.

When Congressman Henry Waxman asked hospitals across the 50 states if they were using the checklist, I told him that we should also ask: are the hospitals measuring results? And, if so, what are they? I wanted to know whether patients were really safer. At many hospitals our first blood stream infection checklist failed because doctors didn't use it. And when nurses tried to remind doctors, they were ignored, or berated. Many were reluctant to speak up. In order to achieve the results we wanted, we had to change the way teams worked together and improve communication. Until a junior nurse can correct a senior physician who forgot to use the checklist, until that conversation goes well, we will continue to harm patients. In most U.S hospitals, that conversation does not go well.

Checklists have a role in improving patient safety. But they only get us part way down the field. To reach our ultimate goal -- making patients safer -- we must engage teams to embrace the concepts behind checklists and become full partners in developing and improving this life-saving tool. And, we must measure our results to make sure that every patient always gets the care they deserve.

Change -- real and permanent change -- is always arduous. Like a New Year's resolution to lose weight, doctors and nurses need a checklist. But, like a dieter, if they don't embrace a permanent commitment to change -- change the way they eat and exercise, monitor their weight along the way -- they fail. The same is true in health care. Unfortunately, checklists alone don't meet these essential criteria.

Our book "Safe Patients Smart Hospitals, How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out," tells the whole story about checklists, and how they are saving 2,000 lives and $200 million annually in Michigan hospitals. Checklist can work, but it's not enough to merely hand doctors a piece of paper, we must respect and acknowledge each member of the care team and measure results.

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