The Value of Checklists — And One That Saved $200 Million and Then Was Banned

The NY Times has an interesting op ed piece by Atul Gawande (whom some have called “the Malcolm Gladwell of doctors”) called A Life Saving Checklist. (The piece is from December, 2007, but remains very relevant.)

The article mentions that basic systems such as checklists have become essential to simplifying the complex task of providing health care. And it is effective — one checklist saved 1,500 lives and $200 million over 18 months. Checklists are a simple but powerful tool for all areas of life — from whatever you have to manage in your own life, to your organization, to industries such as health care.

But the checklist that Atul mentions was banned by the government after 18 months. The government agency that did this meant well, but this serves as a sobering illustration of what happens when process is put over results.

Here are the details from the article:

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government’s decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures.

To see how Gawande answers this logic, read the whole thing.

April 17, 2009 | Filed Under Health Care | 1 Comment 

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