Hacker News Reader

Comment by dx034 | Hacker News Reader

Do they work with checklists? That seems to be the number one reason why crews in aviation can work with such low error rates. Handoffs with strict checklists would probably cause lower error rates.

View on HN

Yes, they do have a lot of checklists, but it's one thing to create a checklist for an airplane with very strict requirements for validation and maintenance and another to create a checklist for a human being.

As others mention, there's a big push towards checklists. (Note: they only work if they are bottom up, not top down.) But aviation mechanics work on something that is heavily standardized, and they get to shut down the thing they are working on, which eliminates a time dimension to the problem. Neither is true for people, so checklists aren't really the solution to the information-handoff problem in medicine.

Can you expand on top down vs bottom up? Do you literally mean reading from the bottom of the page, or starting with the most granular items and decreasing granularity?

Sorry, I mean in an organizational sense. If managers tell workers "Here are checklists! Now follow them!" then they aren't as effective in improving quality as workers saying, "Let's collaborate to make sure we are doing procedure X well. How about a checklist?"

Checklists are an easily observable symptom of an team drive for improvement of outcomes. But you can't reverse that and plop down checklists that are used under threat.

I don't know much about how hospitals work, do doctors even have "managers?" I would figure the doctors would be the ones coming up with and using the checklists.

It's complicated. Doctors employed by hospitals report to two sets of managers. There are other doctors who serve as medical department heads and the chief of medicine. But those doctors are also accountable to non-physician business managers for administrative and financial issues. And then independent self-employed doctors may have privileges at the hospital and see some patients there but don't have managers in the traditional sense.

Crap, I listened to a podcasts sometime last year about how using checklists in a medical setting decreased errors by a ridiculous amount.

I'm going to try to find it. But, if I don't, you got the gist of it:

Have a checklist, and stick to it. Don't expect one person, or even multiple people, to remember all of the steps off the top of their head.

Possibly talking about "The Checklist Manifesto" - http://atulgawande.com/book/the-checklist-manifesto/

It's an -excellent- book about the application of checklists to error reduction etc.

That's exactly it. I knew it was something based on a book. I've updated my comment below, if anyone is looking for the specific radio show about it.

If you find it, post it so I can listen.

I'm having a bear of a time trying to figure out what podcast it was. It might even have been a YouTube video. I've been going through different permutations of search terms to find it.

I'm worried it might have been .NET Rocks![1] They have a great podcast, but their episodes aren't indexed by Google because of their website structure.

I'm gonna keep looking, and even check my home computer's history when I get home tonight, but I wouldn't hold your breath. Someone a bit above linked to a book that I'm pretty sure was the impetus behind the podcast I listened to, so it might be worth giving that a read.

[1] https://dotnetrocks.com/

EDIT: HA! I found it! It was actually in the press section on the book's web page.

http://www.npr.org/templates/story/story.php?storyId=1222261...

Reply on news.ycombinator.com