John Herbert

Atul Gawande was right, and most professions still don't want to hear it. A 19-item checklist cut surgical deaths almost in half. Gawande is a surgeon and writer in Boston. In 2007 he led a World Health Organization project built around one question: what if operating rooms used a checklist the way pilots do? Some of the 19 items almost sound insulting to a trained surgeon. > Confirm the patient's name > Confirm which part of the body you're operating on > Ask how much blood the patient could lose > Count the sponges before the patient leaves the room They tested it in 8 hospitals in 8 cities: Toronto, New Delhi, Amman, Auckland, Manila, Ifakara in Tanzania, London and Seattle. Some had plenty of money and some had very little. They tracked 3,733 patients before the checklist and 3,955 after. Deaths fell from 1.5% to 0.8%. Major complications fell from 11% to 7%. The results came out in the New England Journal of Medicine in January 2009. It wasn't a randomized trial, and the teams knew they were being studied, which can make anyone more careful. So I wouldn't give a piece of paper all the credit. But operating rooms all over the world use that checklist now. We like to think skill is what keeps people safe. Train longer, get better. But skilled people skip simple steps when they're tired or sure of themselves. Pilots found this out in 1935, when a Boeing plane crashed on takeoff and killed two test pilots. The crew had forgotten to release a control lock. Boeing didn't answer with more training. It wrote a checklist. Gawande tells the whole story in a book called The Checklist Manifesto. The expensive mistakes in most jobs come from forgetting what you already know. What's one checklist that has saved you from a stupid mistake?