The Power of Checklists

Adrian recently wrote of the checklist our developers use before declaring that a bug fix or enhancement is truly finished.

In discussing the benefits of checklists Adrian pointed to an article from the National Review of Medicine about the crusade of a Dr Peter Pronovost. The cause that the John Hopkins professor has taken on is somewhat simple but devastatingly effective. His thesis is that the usage of checklists in Intensive Care Units can dramatically decrease complications and therefore deaths and costs.

Compelled to read on, I discovered a New Yorker article by Atul Gawande offering an in-depth review of what the good Dr Peter has been up to and I highly recommend reading it. In discussing Dr Pronovost's results:

Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

His initiative has saved more than fifteen hundred lives in Michigan alone. Do you recall the coverage the so-called 'Subway Hero' Wesley Autrey received last year? He was undoubtedly brave and heroic but where are Dr Pronovost's front page headlines?

When asked how much it would cost for him to do for the whole US what he did for Michigan, he said:

About two million dollars, maybe three, mostly for the technical work of signing up hospitals to participate state by state and coordinating a database to track the results. He’s already devised a plan to do it in all of Spain for less.

When I am unfortunate enough to find myself or a loved one in an emergency room I sure hope they use a checklist. Of all the people in need of funding and support in healthcare research, Dr Pronovost should be at the top of the list.

As Adrian points out, checklists must also be widely applicable to fields beyond medicine. I am sure they would have an impact anywhere where experts are relied on to 'practice an art' yet are busy and stressed. Based upon Dr Pronovost's research, if we all swallowed some humble pie and submitted to a checklist or two the world would be a better place.

I am off to write a checklist or two.