The Checklist Manifesto: How to Get Things Right

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The Checklist Manifesto is an important new book authored by surgeon Atul Gawande. In the book, the author discusses the importance of preparation (using a checklist) to ensure that such things as medical errors are avoided. Gawande makes the point that it takes a system of redundancy to avoid common medical errors. While the book is not solely intended for the healthcare profession, doctors and hospitals should read this book and incorporate his ideas on how to improve healthcare and avoid errors in the future.
Some of his suggestions may appear obvious. For instance, he notes that in a surgical setting those in the room should know each others’ names. That may be obvious, but what procedures are in place in operating rooms across the country to ensure this happens? Checklists help us recognize what’s important and what needs to take place in each and every situation. Completing such checklists helps busy professionals avoid common errors that may be taken for granted in the absence of such a checklist.
The checklist idea is the brainchild of Dr. Peter Pronovost, a critical care specialist at the Johns Hopkins medical center in Baltimore. According to a December 2009 NY Times book review,
“In 2001 Dr. Pronovost borrowed a concept from the aviation industry: a checklist, the kind that pilots use to clear their planes for takeoff. In an experiment Dr. Pronovost used the checklist strategy to attack just one common problem in the I.C.U., infections in patients with central intravenous lines (catheters that deliver medications or fluids directly into a major vein). Central lines can be breeding grounds for pathogens; in the Hopkins I.C.U. at the time, about one line in nine became infected, increasing the likelihood of prolonged illness, further surgery or death.
Dr. Pronovost wrote down the five things that doctors needed to do when inserting central lines to avoid subsequent infection: wash hands with soap; clean the patient’s skin with chlorhexidine antiseptic; cover the patient’s entire body with sterile drapes; wear a mask, hat, sterile gown and gloves; and put a sterile dressing over the insertion site after the line was in.”
While these seemed obvious to everyone, they involved the leading causes of infections in the ICU because they weren’t being followed. The Times continued,
“But Dr. Pronovost knew that about one-third of the time doctors were skipping at least one of these critical steps. What would happen if they never skipped any? He gave the five-point checklist to the nurses in the I.C.U. and, with the encouragement of hospital administrators, told them to check off each item when a doctor inserted a central line — and to call out any doctor who was cutting corners. As Dr. Gawande relates it, “The new rule made it clear: if doctors didn’t follow every step, the nurses would have backup from the administration to intervene.”

Mark Abramson
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