Checklists, checkmate.

Just over a month ago, checklists in medical care = big topic. While some of us may have forgotten the surprising debate, a very interesting David and Goliath battle developed, checklists vs. The Office for Human Research Protections.

Well, according to Wachter’s World (via Health Beat Blog) David won: The OHRP “has concluded that Michigan hospitals can continue implementing a checklist to reduce the rate of catheter-related infections in intensive care unit settings (ICUs) without falling under regulations governing human subjects research.”

As I continue to study (learn is probably more palatable) health care, one of the things that continues to amaze me is how reluctant hospitals (in general) are to learn from other industries–even other hospitals. While eventually hospitals come around (think six sigma, lean production) to at least give (relatively) new ideas a try, it can take exorbitant amounts of time to get there (ah, electronic medical records).

So imagine my surprise when I read an article in the latest issue of Fast Company (web link) by Dan Heath and Chip Heath. Other industries can learn from hospitals? This is good stuff!

“Checklists help us avoid blind spots in complex scenarios. Hospitals have saved thousands of lives by following a simple five-step process for inserting IV lines. Where could your business benefit from a checklist?”

Checklists in medical care seem like a great idea, right?

It has been about a month since Dr. Atul Gawande’s article “The Checklist” appeared in the New Yorker (if you go there to read the article, be prepared…it’s lengthy, but worth the time). If you don’t have the time check out Maggie Mahar’s slightly shorter summary here at Health Beat Blog.

The basic point of the story is this: Dr. Peter Pronovost instituted checklists while working at Johns Hopkins Hospital in critical care. And guess what happened? Dramatically improved care. AND it even saved money.

Dr. Pronovost proceeded to export his checklists throughout the state of Michigan and again a substantial number of patient lives were saved to go along with significant cost savings.

These great results were published in the New England Journal of Medicine and then checklists were rolled out across the country, right? You would think so. But it didn’t happen. In fact, as Ms. Mahar puts it: “In December of 2006, the results were published in The New England Journal of Medicine. How many U.S. hospitals have adopted checklists since? None.”

Why? Well it seems the answer is written here in an op-ed by Dr. Gawande in the New York Times. Ms. Mahar provides her always insightful analysis here and here. The federal agency Office for Human Research Protections is preventing the use of checklists.

That’s a tough pill to swallow. Here we have a health care innovation that saves lives and delivers significant cost savings but is unable to cut through government bureaucracy.

And then after all of that, in a slightly different vein, Reuters has a story from Hong Kong on the use of checklists.

UPDATE: Some more and more on checklists.