zondag 13 mei 2012

Why so many surgeons don't use checklists?

In reaction to my former post on the video of Atul Gawande: 'How do we heal Medicine?' Mark Graban replied with (amongst others) the following question:

"When thinks work well, like Lean or checklists, people will want to adopt them, given the right team environment and organizational culture.
I do think it's a curious question of why so many surgeons don't use the checklists in their operating rooms?" 

Last week I read a very interesting article of Carl Weick called 'Drop your tools', where he analyses why a group of firemen did not drop their tools, even though it could have saved their lives. Very powerful insights, on which I might blog later. In this article, Weick proposes a set of possible explanations which I translated to the question that Mark proposes:
Wildland firefighters

1. Does the surgeon trust the person telling him to use a checklist?

2. Does it imply to let something go, which is difficult for the surgeon?

3. Does it effect the way the surgeon currently experiences control?

4. Does the surgeon have the skills required by the new method?

5. Does the surgeon fear negative consequences by adopting the checklist?

6. How does the surgeon perceive the opinion of their peers on using checklist and how does he expect that they will perceive him starting to use it?

7. What is the effect of using a checklist on the sense of identity of the surgeon?

I think the answers to these questions can explain to a large extend the question proposed by Mark on why so many surgeons don't use checklists in their operating rooms. What do you think? Which questions are most relevant and which one would you add to explain it further?

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