Don’t Be a Putz, Wash Your Hands… Use Soap Too!

Key Point: One of the best principles I’ve ever learned is the following: Everything is a process and a process is everything. Anyone who understands this principle appreciates that process and personal judgment go hand in hand. Process is never intended to be mind-numbing bureaucracy. Actually a checklist is usually a reliable method and best-known way of doing something. It is a good thing. One would think that this principle would be comprehensively endorsed and adopted by ALL industries, especially medical practitioners. Apparently this is not the case. Dr. Atul Gawande‘s book and New York Times best seller, The Checklist Manifesto, is about process and checklists. Gawande, a surgeon and author, notes that 93 percent of physicians surveyed wanted checklists used if they were on the operating table, while 20 percent question their value when operating themselves. What’s surprising to me is that process control, according to a number of studies, appears to be at the clinician’s discretion. Yikes… This is like every commercial pilot having their own take off approach protocol, or none at all. I don’t know about you, but I like to see those pilots going through their standard, industry defined safety checks as I board a plane. It actually matters to all on the plane if we take off and land safely.

One of the most distressing points the book makes is regarding simple hand washing. Almost two hundred years after it was statistically proven that hand washing saves countless lives, clinicians are still struggling with compliance (in fact, a May 2010 study indicates that clinicians complied with hand washing guidelines less than half of the time). According to Gawande, this lack of discipline extends into the Operating Room, where he describes complex tasks that must be highly choreographed between many professionals in order to produce positive outcomes that have no script or checkpoints. Geez… If I ever need an operation, I’m going to pin an infection prevention checklist to my chest!

Why do people in most organizations that don’t have strict regulatory guidelines, resist the discipline of checklists? Well apparently part of the reason is the role of our “ego.” We apparently don’t need checklists but others do. My view is that this arrogance can get us in serious trouble regardless of what work we do. Another barrier to checklist application is inertia. It is simply easier to not follow a protocol.

Character Move:

  1. What do you do that requires or would greatly benefit from a checklist and/or reliable process? What do you do to ensure consistent attention to following and improving on these? Be self-accountable and define them.
  2. Does your ego or inertia get in the way of applying and/or inviting others to help you apply these checklists? Processes? Why? What will you do about it? Be respectful and listen to others. Be open to feedback regarding reliable methods you govern.
  3. Do you recognize that a checklist/process/standard method actually can lead to more creativity and mastery? If not you might benefit from exploring this paradox further.

Checklists in The Triangle,



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