In-Situ Procedural Guidance: Saving Lives with a Checklist

Doctors and surgeons are highly-trained individuals and professionals worthy of our trust. However, over 100,000 people die in surgery each year (in the US).

Checklists Work

Atul Gawande ported the successful procedural checklist used in aviation to surgery. He developed his checklist, piloted it, and wrote a book to tell the tale.

In a recent interview with Jon Stewart at the Daily Show, he mentioned that the tasks we take on steadily increase in complexity, so even experts can be helped by reminder mechanisms like checklists.

Why I Love It

There are a bunch of things I love about this. Gawande saw a problem and is trying to solve it using something that already works somewhere else, rather than wasting time trying to reinvent the wheel. Taking things that already work and using them successfully for other things is innovation, too!

Secondly, I agree that the things we do are getting more complex, but there are also temporal factors like stress that play a role. Checklists provide clear guidance on what to do, a distinct path of action to follow in complex situations that require attention to lots of details. The best thing about them though, is that they are used during the situation for which they were made. Instruction manuals provide even more detailed information, but they are usually put away somewhere or to dense with information to use in a hurry.

Screenshot of Xplorer², highlighting the on-screen sidebar help
Xplorer², a file management program, gives procedural instructions in a sidebar on-screen.

This goes to show that having procedural information close at hand makes it easier to answer the question, “so what do I do now?” Xplorer², a file management program and very cool and powerful alternative to Windows Explorer, automatically activates a sidebar with procedural instructions upon first installation. This brilliant feature provides a nice equivalent to the checklist, even though the sidebar’s focus is novice users, while the checklist is for expert professionals.

In any case, consider making procedures more usable by adding some mechanism for in-situ procedural guidance. If you’ve got information available and people aren’t using it, try reducing it to its most crucial elements so that it can be used in a time-sensitive, possibly stressful context.

Cover photo by Jeffery Wong

2 Comments

  1. Victoria said:

    I wish I had seen this last week before my essay on how healers culturally construct disease! Seems like a fascinating book that I must read. Although I too like simple soutions to the complex, I fear it may be a rather mechanistic approach for medicine. May apply to surgeons, but for physicians the complexity of considering biological, socio-economic and individual factors (such as values, lifestyle and personal experience) remains hard to prioritise. Recommend AnneMarie Mol’s ethnography of Dutch hospitals, “The Body Multiple”.

    8 February 2010
    Reply
    • Brian said:

      Victoria,

      I agree that checklists alone are too simple to be used as the sole source of guidance or documentation for complex activities like medicine, surgery, or flying. Their purpose is rather to supplement already-available expertise, documentation, and other materials to ensure that details are not forgotten or skipped, especially in stressful situations where the danger of such oversight is higher than usual. If anything, increased complexity of the things we do make expertise more important, as well as the notion of supplements like checklists.

      What kinds of supplementary information do healers use?

      -Brian

      9 February 2010
      Reply

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