I love American surgeon Atul Gawande’s book ‘The Check List Manifesto‘, which is the inspiration behind the Creative Conflict Model of this blog, which is itself a conflict check list or process discipline. Atul shows very clearly the massive difference, check lists have made to reducing pilot error through the simple expedient of pilot and co-pilot both working through simple check lists, like check under-carriage down on approach to landing and also using them in emergencies to instantly diagnose what is going wrong. We rarely have pilot error crashes any more. One other thing he noted: the hierarchy between pilot and co-pilot has to be broken: the co-pilot has to be able to challenge the pilot and not be intimidated by his senior role.
Atul has made it his life’s work to extend such check lists to other walks of life, especially his own medical profession. And the check lists have to be built by the practitioners, all of the various relevant experts. Well it is long over due. Check out these facts from the US Institute of Medicine’s 1999 report ‘To Err is Human’:
- US surgeons operate on the wrong person or wrong body parts 40 times a week
- One in seven Medicare patients died or were harmed by their hospital care
- 100,000 patients a year die of medical error: that is equivalent to 4 jumbo jets crashing each week of the year, or two US Vietnam War deaths or 30 9/11s every year
- Yet adopting Atul’s check list approach, 1500 lives were saved in 18 months in Michigan in Intensive Care Units
- But here is no sign the medical profession or health systems are getting on board on this. Their arrogance is astounding.
- And one reason I suspect for this, is that process discipline requires flattening hierarchy. A nurse or anyone else on the surgical team in an operating theater has to be able to challenge a surgeon if he departs from the check list. Tough for such a hierarchical profession to accept that the check list is in charge
So let me add two personal anecdotes to reinforce this message. In January 2010, while visiting St Louis, I fell and cut my head open, and my friend Dan took me to his local ER in a poor district of the city. As we arrived, and I stated the problem, they sat me down and in roughly two minutes (I timed them) they had worked down a check list: they established exactly what had happened and entered it into a computer, along with my baseline pulse, temperature, blood pressure, established my allergies, put a name tag on my wrist including allergy information, and had a doctor on the phone who asked questions, and would have come instantly if I had in fact lost consciousness at any time. I was there for two hours and every step of their approach and treatment was driven by a check list, or so it felt. Outstanding disciplined treatment.
The same week my friend Gordon suffered from acute abdominal pains. He was taken by his wife to the ER in a wealthy suburb of Detroit. He told the receptionist his problem and was asked to wait. No questions, no triage, no check list. He waited for 45 minutes and then collapsed on the floor with pain. The ER staff rushed up, and put him on a gurney, took him into a treatment room and injected him with a powerful pain killer without questioning him, and stopped his heart as he had a known allergy to this pain killer. Having killed him in error, they then resuscitated him successfully. The possible fatal consequences of no check list, no process discipline.
The story gets worse. Gordon is an expert in Lean Manufacturing and process discipline. He went to the hospital and met with a senior manager. He said: ‘This is what happened. I am not going to sue you but I want you to learn from your mistake so you don’t kill anyone else.‘ They showed zero interest. I guess I would have sued their ass off to get them to listen.
Which brings us back to what I call conflict discipline. Using the ‘Seven Step Creative Conflict Model’ of this blog to handle your conflict, or use any other conflict discipline, like that of ‘Getting to Yes’ by Roger Fisher and Bill Ury. Don’t just take a few vague ideas from this blog, like creativity in conflict oh yes. Use the bloody process, or some process, in writing to overcome our natural tendency to be self-righteous, biased, uncreative, un-empathetic and uninterested in the reality or detail of what we face. Do it.
And if you are in the medical profession, get on Atul’s program and stop killing 100,000 of us in the USA or far more in other countries, right now. Please.
This is the marvelous Atul: see http://en.wikipedia.org/wiki/Atul_Gawande
Footnote: When I was 10 I fell ill and was hospitalized and diagnosed and treated for osteomyalitis or bone marrow infection, and after 6 weeks declared ‘cured’. As indeed I was because I did not have this disease in the first place. My symptoms worsened, but the unbelievable stupid orthopedic doctors insisted I was just a malingerer trying to get attention. After 12 months of growing immobility and pain, my parents took me to a pediatrician, the splendid Dr. Bray, who correctly diagnosed my condition as juvenile arthritis in about ten minutes examination and I spent 5 months in hospital being treated for this condition successfully. I suspect Dr. Bray had a mental checklist.