Preventable medical errors remain the third highest cause cause of death in the US – following heart disease and cancer. They claim the lives of 400,000 Americans every year. In the following TED talk, Boston surgeon and public health researcher Dr Atul Gawande talks about the World Health Organization (WHO) approaching him to research possible methods of reducing avoidable surgical deaths.
What Gawande discovered was that the role of doctors has failed to keep up with the increasing complexity of medical technology. Prior to the discovery of penicillin in 1945, most patients who were ill enough to be hospitalized died. Occasionally a courageous doctor would save a patient with heroic and/or revolutionary treatment. This caused doctors who were daring “cowboys” and “pioneers” to be sought out and rewarded.
In the new millennium, Gawande argues, amazing new technologies, rather than brilliant doctors, are saving patients. Although the increasing complexity of medical technology requires ever larger medical teams, the health system is still oriented around the skill and expertise of individual doctors. We’re still relying on the brilliance of individuals. What we really need is pit crews.
Gawande approached the challenge WHO gave him by looking at other high risk professions, such as skyscraper construction and aircraft manufacture. He wanted to see what they did to reduce the risk of avoidable errors.
He was inspired by the checklists Boeing uses at every stage of manufacturing – for key details that can get forgotten. He developed a similar series of surgical checklists, which he tested in a dozen different countries. The checklists reduced complication rates by 35% and death rates by 45%.
Gawande published his remarkable findings in the New Yorker in 2007 and in a 2009 book, The Checklist Manifesto.
Seven years later the majority of hospitals and surgical teams refuse to implement Gawande’s checklists – for reasons he fails to specify. Apparently their responsibility in the deaths of hundreds of thousands of patients isn’t sufficient to inspire change. I must admit this mystifies me.