A Lifesaving Checklist
Atul Gawande,
New York Times,
Jan 02, 2008
Things that seem really obvious aren't always so. And though it comes from the field of medicine, this debate over the use of checklists is illustrative. The story, in brief, is that a hospital decided to try using checklists to ensure proper procedures are followed, and were following up by evaluating the results to see whether it worked. More detail here. And although it appeared to work, the program was halted, because it violated ethics regulations. Specifically, you can't experiment on people without their knowledge or consent. OK, fair enough, but what about when something is obviously successful, like checklists? Surely the regulations weren't intended to stop that!
But they were. The problem is, they're not "obviously" successful until after the experiment. And also, the definition of "obviously successful" varies. We here in the Maritimes remember well the Swissair crash off Peggy's Cove in 1998. The efficient air crew followed the checklist to the letter, including taking an extra loop around the airport to dump fuel in the ocean. That's what did them in - that extra few minutes in the air, during which their electronics burned to a crisp.
Checklists do work, which is why airliners still use them. But there is a lot to learn about how they should be used. The air crew had no way to know what would happen. But, if following the checklist caused a patient to die, and if the doctor knew full well this would happen, do you continue the experiment? Not without the patient's consent you don't - and by that implication, the research program must be shut down.
But they were. The problem is, they're not "obviously" successful until after the experiment. And also, the definition of "obviously successful" varies. We here in the Maritimes remember well the Swissair crash off Peggy's Cove in 1998. The efficient air crew followed the checklist to the letter, including taking an extra loop around the airport to dump fuel in the ocean. That's what did them in - that extra few minutes in the air, during which their electronics burned to a crisp.
Checklists do work, which is why airliners still use them. But there is a lot to learn about how they should be used. The air crew had no way to know what would happen. But, if following the checklist caused a patient to die, and if the doctor knew full well this would happen, do you continue the experiment? Not without the patient's consent you don't - and by that implication, the research program must be shut down.
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