In the airline industry they have checklists. In Japan, train operators point and vocalize. In my volunteer fire department, we've adopted a "two sets of eyes" policy on all technical rope rigging before declaring it ready.
I know humans are fallable, but I feel like there are some basic, workplace culture driven techniques that could substantially help here.
There's plenty of checklists in the medical field as well. Specially during triage of all kinds.
The main issue is that in most jobs people will say new checklists won't work for /them/ because they understand it better than the checklist, or because the checklist will slow them down. Think about your own work and you'll find reasons why checklists don't make sense, I bet.
I once went in for a surgery on a foot and when rolled into the room the doctor asked me if I had any last minute questions and I asked only 'which foot are you operating on'. After a few seconds of confusion he gave a decisive right answer and even told me 'here, if it makes you feel better I'll sharpie your leg'. And it did make me feel better - there's so much that can easily go wrong by a minor mistake from them which will be life changing for you.
Alarming that that was a last minute question and an "if it makes you feel better" offer, honestly, even if it obviously went fine. On the day of my surgery I was constantly being asked what it was and on which side, by nurses, by the anaesthetist, the surgeon came and saw me on the ward beforehand and verbally confirmed it, palpated the correct area, and drew on me, and then on the bed before they put me under I was asked to lift the blanket and show there was an arrow and confirm that it was correct in front of basically the entire team. It would've been literally impossible to doubt that they knew what they were supposed to do.
Usually they are supposed to pro-actively ask you that I think. When I had a fracture in my upper arm everyone would ask me which arm it was. The patient is a good independent backup for easy flip/flop errors.
Error correction
> in most jobs people will say new checklists won't work for /them/ because they understand it better than the checklist, or because the checklist will slow them down.
I fought this fight for a long time as an executive in charge of ops with a team that had a critical enterprise product and refused to use source control.
Sharpie marking for surgery before you're out of it seems pretty common, at least the ~3 times I've had anything done on one side.
Why not put all post surgery patients through a cheap metal detector? Would at least catch stainless steel instruments.
You'd need to do it before you close them up. Maybe a sterile wand?
My understanding is a lot of these things get RFID tags so they can be identified.
And barcoded for quite some time.
> In the airline industry they have checklists
Yes, and The Checklist Manifesto (which is a fantastic book) was published in 2009; yet it seems little progress has been made since.
It's not just checklists, though, it's also basic CRM. If the lead surgeon is God, and you're a nurse, you don't speak up -- you probably don't even believe your own senses when they tell you something's wrong.
A fundamental change is sorely needed -- not sure what will make it happen.
The Checklist Manifesto is good, but it was a little confused over what checklists are.
Almost all of the examples discussed are actually checklists: before you do something, you go over the checklist and make sure whatever it says to do has been covered.
But the example of soap distribution in India isn't like that at all. The notional "checklist" was a list of several circumstances in which you should use soap:
1. Before preparing food.
2. After using the bathroom.
3. After wiping an infant.
4. [There were others; I don't remember them.]
This is a good and valuable set of information to publicize. But it isn't a checklist. Interpreted as a checklist, you would need to check it before and after every action you ever take. That is obviously not something people can do. You use this list by doing the work of modifying your relevant habits to include "wash with soap" at an appropriate stage, which is exactly the kind of approach to doing things that the rest of the book is telling you doesn't work.
There absolutely exist checklists for safe surgery as well, most famously the WHO Surgical Safety Checklist [pdf]: https://iris.who.int/bitstream/handle/10665/44186/9789241598...
It's definitely widely used in Germany, where I work. I don't know how common it is in the US, though.
I often think about what makes medicine so different from aviation and your other examples, culture-wise. It's not like there's no safety culture at all in medicine, but clearly these kinds of structures are deployed to a much lower extent.
One major reason might be the far larger diversity of possible situations in medicine. It's possible to make a checklist for surgical safety because every surgery is similar, same to how every plane flight is similar. But if I think about, for example, harm due to adverse effects from medications, or missed abnormal values in blood tests, it feels very difficult to create a checklist to prevent those that would be specific enough to be useful, but also general enough to capture all important situations these might arise in.
In this sense, I think certain “low-hanging fruit” of safety culture improvements have already been captured in medicine. Apart from surgical safety, I can think of check lists for chemotherapy administration, for blood transfusions, for management of a severe allergic reaction, and other specific individual things. Pointing and vocalizing is also done in surgery, albeit in a less formal way. “Two sets of eyes” policies exist in e.g. pathology for more certainty in diagnosis of cancer.
Nevertheless there is clearly room to improve, as evidenced by the continuing occurrence of “never events” such as retained foreign bodies in surgery. There are certainly economic factors at play here as well: unlike in the free market, in the medical system there is often very little economic incentive for quality, and the same principle I mentioned before — of the immense diversity of possible situations — makes top-down regulation very tricky.
Maybe part of it is also that the potential harm from a retained foreign body is much lower than the potential harm from a plane crash. And maybe medical care is so much more common than plane flights that by base rate alone, mistakes in the former will be much more common. Yet I still think there is much that can be done, and I am unsure what exactly is preventing that from happening.
> One major reason might be the far larger diversity of possible situations in medicine
Yes but the major is the number of deaths. An incompetent surgeon can kill at most one person at a time. Besides, variance in surgery is much higher than in aviation.
Also, if the pilot screws up, he can die too. Surgical screwups are not going to kill the surgeon.
not to be pedantic, but the examples you're describing are _process_, not _culture_.
Examples of culture would be: do nurses feel comfortable speaking up / questioning the lead surgeon? do surgeons feel like they can voice when they're overworked without fear of being perceived as a failure?
What kind of jobs is the rope rigging supposed to handle?
(I think knots are cool, but I don't really know of motivating examples for why I would hypothetically need them.)