from anaesthesia equipment or drug errors lead to extensive efforts to prevent their recurrence . Other less dramatic errors are more common – patients developing wound infections when antibiotics are not administered or suffering thromboembolic complications – where a clot obstructs a blood vessel - when prophylaxis is omitted .
Although less newsworthy , the complications for the patient may be equally or more catastrophic . A growing number of healthcare providers are trying to learn from aviation accidents and , more specifically , from what airlines have done to prevent them . Surgeon and journalist , Dr . Atul Gawande ’ s book , The Checklist Manifesto : How to get Things Right , draws lessons from the aviation industry and pinpoints checklists as being an effective way to reduce errors in healthcare . In his book , Dr . Gawande recounted his experience working with a team from the Harvard School of Public Health to design and implement a surgical checklist as part of a WHO project to reduce adverse events from surgery . He borrowed the checklist idea from other industries , including aviation , to operate complex machinery without forgetting to perform each small but vitally important step .
The World Health Organization ( WHO ) Surgical Checklist , part of their “ Safe Surgery Saves Lives ” Campaign , introduced only in 2008 includes checklist ( Sign In ), a briefing ( Time Out ) and a checklist with a short briefing at the end ( Sign Out ). Checklists are suited to the verification of procedures for linear processes , whereas briefings are suited to support the execution of complex processes that may require appropriate adaptation and variation . Briefings are crucial because surgical outcomes are complex and emergent , with the optimal performance and outcomes of surgical procedures requiring the flexibility to accommodate the unexpected but being prepared nonetheless . In those hospitals in which the checklist was enforced , surgical complications decreased on average by more than a third . That is a significant reduction , and saved hundreds of lives . Dr . Gawande argued that checklists are effective because some systems in our civilisation have become too complex for the human mind to master .
Suzanne Gordon and Patrick Mendenhall , the co-authors of the book , Beyond the Checklist : What Else Can Health Care Learn From Aviation Teamwork and Safety , examined how CRM , applied in the aviation industry , allows pilots , flight attendants , and ground crews to communicate and cooperate more effectively , leading to great reductions in the hazards of commercial air travel . They argued that CRM should be more widely adapted and applied to healthcare delivery .
In the execution of procedures , the human brain may be subject to three key cognitive limitations : we may forget to retrieve one of a number of steps in a procedure ; we may retrieve a step but for one reason
Many preventable medical blunders happen in the operating theatre
or another ( e . g . distraction , fatigue ) may not remember to carry it out ; or we may retrieve the step , remember to carry it out , but execute the action incorrectly . In healthcare , the “ humble checklist ” has increasingly been applied to include the fields of surgery and infection control and there are also attempts to reap the benefits of checklists to avoid errors in medical diagnosis .
In healthcare , optimising patient safety should be the cornerstone of everything we do . We need to get back to basics with the “ humble checklist ,” employ this important tool for processes that are linear , simple , standardised and ( perhaps ) time critical . Whilst it is tempting and appealing to embrace a single tool to improve patient safety , the fact is that the complexity of quality and safety improvement in healthcare will never be singular , straightforward or simple to sustain . It demands the commitment of resources , sound , robust leadership , and occasionally , even an organisational culture change . n
Dr . Vincent Chia is a healthcare consultant and CEO of Asian Healthcare Solutions , a Singapore-based consultancy firm that advises healthcare investors and providers on how to improve care delivery and clinical outcomes . He is also the former CEO of Gleneagles Hospital in Singapore .
GlobalHealthAndTravel . com ISSUE 5 | 2024
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