During a three-month test across eight hospitals, several continents, and almost 4,000 patients, a new technology reduced serious surgical complications by 36% and deaths by almost 50% — in raw numbers, over 150 cases of severe harm and nearly 30 patient deaths.
This performance was demonstrated in the spring of 2008 with the prototype version of the technology, applied indiscriminately to surgeries of all kinds — a prototype without the specialized features that would improve performance in (for example) abdominal, cardiac, or neurosurgical procedures.
The surgeon who spearheaded the development and deployment of this technology should, in my view, be the leading candidate for the next Nobel Prize in Medicine. He has earned it, and awarding the Nobel Prize for this accomplishment would speed the adoption of a technology proved to save lives in settings that range from leading surgical centers in the US and UK to a remote hospital in Tanzania.
The prototype hardware consists of a sheet that lists 19 carefully engineered steps. The first step after sign-in — proved by testing to be crucial — is a pause in which the members of the surgical team simply introduce themselves to one another by name.
The name of this innovative surgeon is Gul Gawande, and he’s told the story of the technology in an excellent and many-faceted book, The Checklist Manifesto.
It’s a good read that offers concrete and compelling insights into why buildings stand and aircraft seldom fall out of the sky. Ultimately, it’s about cognition, complexity, knowledge-sharing, and team coordination, all vividly illustrated with stories of surgery gone wrong (and right) and extended in surprising directions with tales of success that range from methodical heroism in modern aviation to methodical investment in high-tech venture capital.
I had planned to skim the book, but after picking it up yesterday I read it cover to cover.
A carefully engineered checklist is a high-value medical technology by any measure you choose. It averts injury, saves lives, saves money, improves morale, and reduces staff turnover. It costs virtually nothing. Only inertia holds it back, and what the humble checklist needs most now is an infusion of glamor and excitement. A Nobel Prize for Dr. Gawande would do more than recognize accomplishment: It would give a boost to a critical technology that could save your life.
Here’s the journal article:
“A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population” (New England Journal of Medicine, 2009).