“Intensive-care medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered,” Atul Gawande explains in his article about Peter Pronovost’s simple but powerful idea.
For many families, “managing extreme complexity” might also describe parenting in the 21st Century. Can what Peter Pronovost is using to save lives in hospitals help parents? Or, as Gawande’s December 10 article in The New Yorker asks in its sub-head, “If something so simple can transform intensive care, what else can it do?”
Pronovost’s simple idea is a checklist. “If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it,” says Gawande in his article. (Gawande is a staff writer at The New Yorker. He is also a surgeon at Brigham and Women’s Hospital, Boston and an assistant professor of surgery at Harvard Medical School. In 2006, he received the MacArthur Award for his research and writing.)
Gawande explains that the puzzle of intensive care is “you have to make sure that a hundred and seventy-eight daily tasks are done right—despite some monitor’s alarm going off for God knows what reason, despite the patient in the next bed crashing, despite a nurse poking his head around the curtain to ask whether someone could help “get this lady’s chest open.” So how do you actually manage all this complexity?”
The medical industry’s response has been to create a “super-specialist” for ICU care.
Peter Pronovost says, instead, a simple, better, management technique is what is needed in hospitals. Gawande tells the story of how using “a checklist” instead of depending on better training is what made it possible for pilots to fly complex, modern airplanes. Would a checklist work in ICUs?
In 2001 a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. “He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check,” reports Gawande.
“These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.”
Gawande says that Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them.
Why did it work?
“The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events….
“A second effect was to make explicit the minimum, expected steps in complex processes.”
You can read Gawande’s 7,800 word article (well-worth the time) online here:
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
WuduPlz’s presents a checklist of household tasks with a means to easily and simply communicate to family members what needs to be done, when it needs to be done. If this kind of management can work well for doctors in a hospital and pilots in fighter jets, perhaps it should be tried in homes as well.
Family life–which is suppose to be loving and caring–may not sound to some like a place that could be better served with a checklist. It doesn’t sound “natural.” But, then, it doesn’t sound like doctoring to some people, either.
Using a checklist “pushes against the traditional culture of medicine,” explains Gawande. Some families who try using checklists are sure to feel the same or get some push-back from others.
“It’s ludicrous, though, to suppose that checklists are going to do away with the need for courage, wits, and improvisation,” he concludes. “Good medicine will not be able to dispense with expert audacity. Yet it should also be ready to accept the virtues of regimentation.” I suggest that the same could be said of running a household.
Therefore, I’ll attempt to answering the question the New Yorker headline asked (“If something so simple can transform intensive care, what else can it do?”) and point families to WuduPlz.
