Word: checklists
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...checklist is kind of an effort to produce a consistent Hawthorne effect," says Gawande. "It is intended to make people aware that other people expect these things to be done." Researchers checked whether teams behaved differently when the researchers were present and when they were not and found no difference...
Gawande disagrees with Pronovost's critique. "There's a synergy between the items on the checklist," he says. "Any one thing at any given time might not add up to much, but the net effect of all of it put together - especially making for more effective teamwork - matters...
Gawande believes his checklist has already saved at least one life in his operating room, where he performs eight to 10 procedures a week. Like many doctors, he resisted using it at first. "I thought, 'Oh, I've got to do this checklist because I designed the thing.' I didn't expect to see a difference...
However, in one case where he was preparing to remove an adrenal tumor, the anesthesiologist realized during the checklist rundown that extra blood might be required but was not on hand. The blood was delivered to the OR - and the patient did need it during surgery. "I'm convinced that the fact that the anesthesiologist caught that was what saved this man's life," Gawande says, adding that his team averts at least one potential problem via the checklist every week...
Whether these changes can be sustained over time is another question. Gawande and his colleagues note in the study that a phenomenon called the "Hawthorne effect" may be largely responsible for the checklist's success. The effect was named for a series of experiments designed to determine how to increase productivity at a factory in Chicago. All of the tactics implemented by the study leaders improved worker output during the experiments - but researchers realized that the effect they were really measuring was a boost in motivation among workers who knew others were watching...