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Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
Checklist manifesto
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Checklist manifesto

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  • 1. The Checklist Manifesto - A Review Astha Gupta, M.Sc MHA PAHM
  • 2. How to get thing Right 2 “1000 things can go wrong when you’ve got a patient with stab wounds” Anaesthesiologist used the wrong concentration of Potassium No one remembered to ask the ER team what the weapon was
  • 3. How to get thing Right 3 “1000 things can go wrong when you’ve got a patient with stab wounds” Two main reasons of failure • Ignorance (Don’t know or know partially) • Ineptitude (Know but fail to apply) • Ignorance (1950s – heart patient put on bed rest for weeks in order to avoid strain to heart) • Ineptitude (2006 - only 50% of hospitals had achieved door to balloon of less than 90 min)
  • 4. Healthcare and its extreme complexity 4 • Complexity at two levels • Diagnosis – ICD 10 14000 codes with open sections for further specificity. ICD-10 CM 68000 • Treatment – 24 hours period in an ICU requires 178 actions either by a nurse or a doctor In Indian ICUs, the rate of vancomycin-resistant enterococcus (VRE), a dangerous hospital infection, is five times the rate in the rest of the world • What do you do when expertise is not enough? • What do you do when super-specialists fail?
  • 5. Learning from similarly complex sectors 5 Aeronuatics • 1930s saw a major crash of Boeings newly commissioned aircraft • Since then, the same fleet has completed 1.8 million flights without a single accident But we are much more complex • 41000 trauma patients in one state in US led upto 32261 unique combinations of diagnosis Think again • Nursing uses a simple checklist which forms the basis of most complex diagnosis till date • John hopkins – 5 point checklist for preparation towards inserting a central line reduced ten day line infections from 11% to zero (2001)
  • 6. 6 Helps in memory recall Organises tasks Argument remains…Human body is far more complex!!!!
  • 7. Learning from similarly complex sectors contd… 7 Construction • Building is a like a human body • Involves 16 separate specialities to come together • Checklist for • Every tasks under the plan • Every foreseen adversary • Communication and handling of the unforeseen • Checklist work – 0.00002% rate of building failures
  • 8. 8  Helps in memory recall Organises tasks Essential to complex environments Helps in decision making
  • 9. Learning from similarly complex sectors Contd… 9 Investment Funds • Multiple levels of study • Financials, culture, market outlook etc • Growth prospects etc • Multiple teams working together • Sectors of investment can be as varied as healthcare at one and mining at other end
  • 10.  Helps in memory recall  Organises tasks  Essential to complex environments  Helps in decision making 10  Inculcates discipline into the process  Process back in focus “FLY THE PLANE”  TEAM WORK
  • 11. Why Us? 11 • Volumes of surgery exceeds the global totals of childbirth only with death rate 10-100 times higher • Surgeries leave 7 million people disabled and 1 million dead every year. (A rate comparable with any public health concerns like malaria, tuberculosis etc) • The unhealthy proposition of healthcare “One in four surgeons believe juniors cannot question seniors” 64% 39% 28% 10%
  • 12. The Worrisome Replacement 12 Healthcare Skill Trustworthiness Selflessness Discipline
  • 13. The Worrisome Replacement 13 Healthcare Autonomy
  • 14. The WHO Intervention 14 Checklist - The soap of surgical care • Simple • Transmissible • Measurable Counter the four roadblocks of Surgery • Infection • Bleeding • Unsafe anaesthesia • Unexpected - Communication The pause points • Before Anaesthesia Seven Checks • After Anaesthesia Seven Checks • Before Wheeling Out Five Checks
  • 15. Good Checklist 15 • To the point • Easy to use • Does not spell out the steps • Reminders of the most important and critical steps (Data suggested as most critical and most frequently missed) • Makes priorities clearer • Has simple and exact wording • Always in sentence case • The pilot flying cannot start the checklist (he has a task at hand running through his head) • 60-90 seconds Do Confirm Read - Do
  • 16. What checklists cannot do 16 Make people use them Be applicable for all conditions Decide inclusions/exclusions Tide over hierarchical structures Increase workload
  • 17. Essential to Implementation 17 • Top down push for bottoms up implementation • Customized to situation with common DNA • Display positive effects with complying few • Those essential to implementation need to be pulled in via management • Can lead to change in established practices
  • 18. Way Ahead 18 Specialised Checklist • Hip Replacement Disaster/Emergency Control • Like in Aviation Team work and discipline
  • 19. About the Author 19 • Atul Gawande is an Indian American surgeon and journalist. • He is widely known as an expert on reducing error, improving safety, and increasing efficiency in modern surgery. • General and endocrine surgeon at Brigham and Women's Hospital in Boston, Massachusetts • Associate director of BWH Center for Surgery and Public Health. • Associate professor at Harvard School of Public Health • Associate professor of surgery at Harvard Medical School. • He has written extensively on medicine and public health

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