In the airline industry they have checklists. In Japan, train operators point and vocalize. In my volunteer fire department, we've adopted a "two sets of eyes" policy on all technical rope rigging before declaring it ready.
I know humans are fallable, but I feel like there are some basic, workplace culture driven techniques that could substantially help here.
vasco 3 hours ago [-]
There's plenty of checklists in the medical field as well. Specially during triage of all kinds.
The main issue is that in most jobs people will say new checklists won't work for /them/ because they understand it better than the checklist, or because the checklist will slow them down. Think about your own work and you'll find reasons why checklists don't make sense, I bet.
I once went in for a surgery on a foot and when rolled into the room the doctor asked me if I had any last minute questions and I asked only 'which foot are you operating on'. After a few seconds of confusion he gave a decisive right answer and even told me 'here, if it makes you feel better I'll sharpie your leg'. And it did make me feel better - there's so much that can easily go wrong by a minor mistake from them which will be life changing for you.
recursivecaveat 3 hours ago [-]
Usually they are supposed to pro-actively ask you that I think. When I had a fracture in my upper arm everyone would ask me which arm it was. The patient is a good independent backup for easy flip/flop errors.
cma 2 hours ago [-]
Why not put all post surgery patients through a cheap metal detector? Would at least catch stainless steel instruments.
5555624 1 hours ago [-]
You'd need to do it before you close them up. Maybe a sterile wand?
VectorLock 6 minutes ago [-]
My understanding is a lot of these things get RFID tags so they can be identified.
bambax 2 hours ago [-]
> In the airline industry they have checklists
Yes, and The Checklist Manifesto (which is a fantastic book) was published in 2009; yet it seems little progress has been made since.
It's not just checklists, though, it's also basic CRM. If the lead surgeon is God, and you're a nurse, you don't speak up -- you probably don't even believe your own senses when they tell you something's wrong.
A fundamental change is sorely needed -- not sure what will make it happen.
thaumasiotes 1 hours ago [-]
The Checklist Manifesto is good, but it was a little confused over what checklists are.
Almost all of the examples discussed are actually checklists: before you do something, you go over the checklist and make sure whatever it says to do has been covered.
But the example of soap distribution in India isn't like that at all. The notional "checklist" was a list of several circumstances in which you should use soap:
1. Before preparing food.
2. After using the bathroom.
3. After wiping an infant.
4. [There were others; I don't remember them.]
This is a good and valuable set of information to publicize. But it isn't a checklist. Interpreted as a checklist, you would need to check it before and after every action you ever take. That is obviously not something people can do. You use this list by doing the work of modifying your relevant habits to include "wash with soap" at an appropriate stage, which is exactly the kind of approach to doing things that the rest of the book is telling you doesn't work.
It's definitely widely used in Germany, where I work. I don't know how common it is in the US, though.
I often think about what makes medicine so different from aviation and your other examples, culture-wise. It's not like there's no safety culture at all in medicine, but clearly these kinds of structures are deployed to a much lower extent.
One major reason might be the far larger diversity of possible situations in medicine. It's possible to make a checklist for surgical safety because every surgery is similar, same to how every plane flight is similar. But if I think about, for example, harm due to adverse effects from medications, or missed abnormal values in blood tests, it feels very difficult to create a checklist to prevent those that would be specific enough to be useful, but also general enough to capture all important situations these might arise in.
In this sense, I think certain “low-hanging fruit” of safety culture improvements have already been captured in medicine. Apart from surgical safety, I can think of check lists for chemotherapy administration, for blood transfusions, for management of a severe allergic reaction, and other specific individual things. Pointing and vocalizing is also done in surgery, albeit in a less formal way. “Two sets of eyes” policies exist in e.g. pathology for more certainty in diagnosis of cancer.
Nevertheless there is clearly room to improve, as evidenced by the continuing occurrence of “never events” such as retained foreign bodies in surgery. There are certainly economic factors at play here as well: unlike in the free market, in the medical system there is often very little economic incentive for quality, and the same principle I mentioned before — of the immense diversity of possible situations — makes top-down regulation very tricky.
Maybe part of it is also that the potential harm from a retained foreign body is much lower than the potential harm from a plane crash. And maybe medical care is so much more common than plane flights that by base rate alone, mistakes in the former will be much more common. Yet I still think there is much that can be done, and I am unsure what exactly is preventing that from happening.
eastbound 44 minutes ago [-]
> One major reason might be the far larger diversity of possible situations in medicine
Yes but the major is the number of deaths. An incompetent surgeon can kill at most one person at a time. Besides, variance in surgery is much higher than in aviation.
thaumasiotes 1 hours ago [-]
What kind of jobs is the rope rigging supposed to handle?
(I think knots are cool, but I don't really know of motivating examples for why I would hypothetically need them.)
hhh 4 hours ago [-]
My mother had rags left in her during a surgery that ended up fucking up the course of her life forever and leaving her permanently disabled. The rags didn’t cause the primary problem, but were just a part of their shoddiness.
Of course it’s not every surgeon, but there are some butchers that out happens more with. It ended up being a repeat problem for my mother’s surgeon.
keepamovin 2 hours ago [-]
Seems there should be a "check in" "check out" list, managed by one of the other staff, and double checked by another, ideally.
Or even some form of RFID tagging and a scan wand.
iancmceachern 2 days ago [-]
This is definitely a thing, they do all kinds of things like counting things before and after the surgery to avoid it.
spondylosaurus 5 hours ago [-]
Fifteen or 20 years ago I remember seeing something about using bar codes to "check out" and "check in" all the tools so nothing was unaccounted for. Unclear if that system's been widely adopted, though.
duk3luk3 3 hours ago [-]
They do something like that in aircraft manufacturing - every tool has a dedicated spot in the toolbox and a job can't be signed off unless all the tools are back in the toolbox. Bolts, nuts, and other parts/debris are a different story though... there's horror stories from that as well, especially recently from one of Boeing's facilities implicated in the string of manufacturing and maintenance related incidents Boeing had in the last couple years.
hulitu 2 days ago [-]
"Dottore, still counting ? Hurry up, there are 10 more patients avaiting surgery today. The profit of the company and your bonus are in danger. Hurry up"
gregoryl 5 hours ago [-]
You could frame it a different way; what level of risk would be acceptable vs. the reduction in cost/time/use of resources. If you're 10% faster for 0.1% risk, is that a better outcome for society?
hansvm 5 hours ago [-]
You could, but the willingness to frame it that way at a local decision-making level causes problems for global optimization. It's perfectly fine for a surgeon to triage patients and actions. It's much less fine for a hospital administrator to decide they can get away with less staff because the increase in risk isn't _that_ high (maybe only a couple extra deaths per year). Perhaps it's fine to make that tradeoff, but the blatant conflict of interest and history of people doing worse things for less money suggests it should at least have oversight.
nkrisc 5 hours ago [-]
How would you feel being the 0.1% for the betterment of society? Your sacrifice is appreciated!
anonymars 4 hours ago [-]
We are all already part of this conversation, all the time, because resources are finite
The flip side is "sorry, we didn't have enough surgeons available right now so we have to triage you", or, "sorry you can't afford the bill"
I'm sure in this particular situation the numbers benefit "don't leave surgery debris in the patient" but the more general point remains, there is some set of numbers (likely implausible) where it would flip the other way
daedrdev 37 minutes ago [-]
10% faster could easily be more than 0.1% better for society. Less risk for infection or other problems, more people can be seen etc. Its entirely about weighing pros and cons and you are being ignorant by assuming otherwise.
FirmwareBurner 4 hours ago [-]
Hate it all you want but these decisions of how much percentage death is legally allowed happens whether you like it or not. Otherwise we'd have no cars on the road, no planes in the sky, no boats, no swimming, no cycling, etc
I wonder how the frequency compares with other countries. Is this as common in Europe or in Asia? Or even Mexico or Canada?
logicchains 3 hours ago [-]
Not all surgeons are alike, just as in any profession: some make many errors and some make few. But doctors unions fight tooth and nail to prevent the publication of information that would allow patients to make informed decisions about their surgical provider, which removes the financial incentive for surgeons to do better and prevents bad surgeons from being weeeded out of the market.
giardini 5 hours ago [-]
Unworthy.
Rendered at 09:30:09 GMT+0000 (Coordinated Universal Time) with Vercel.
I know humans are fallable, but I feel like there are some basic, workplace culture driven techniques that could substantially help here.
The main issue is that in most jobs people will say new checklists won't work for /them/ because they understand it better than the checklist, or because the checklist will slow them down. Think about your own work and you'll find reasons why checklists don't make sense, I bet.
I once went in for a surgery on a foot and when rolled into the room the doctor asked me if I had any last minute questions and I asked only 'which foot are you operating on'. After a few seconds of confusion he gave a decisive right answer and even told me 'here, if it makes you feel better I'll sharpie your leg'. And it did make me feel better - there's so much that can easily go wrong by a minor mistake from them which will be life changing for you.
Yes, and The Checklist Manifesto (which is a fantastic book) was published in 2009; yet it seems little progress has been made since.
It's not just checklists, though, it's also basic CRM. If the lead surgeon is God, and you're a nurse, you don't speak up -- you probably don't even believe your own senses when they tell you something's wrong.
A fundamental change is sorely needed -- not sure what will make it happen.
Almost all of the examples discussed are actually checklists: before you do something, you go over the checklist and make sure whatever it says to do has been covered.
But the example of soap distribution in India isn't like that at all. The notional "checklist" was a list of several circumstances in which you should use soap:
1. Before preparing food.
2. After using the bathroom.
3. After wiping an infant.
4. [There were others; I don't remember them.]
This is a good and valuable set of information to publicize. But it isn't a checklist. Interpreted as a checklist, you would need to check it before and after every action you ever take. That is obviously not something people can do. You use this list by doing the work of modifying your relevant habits to include "wash with soap" at an appropriate stage, which is exactly the kind of approach to doing things that the rest of the book is telling you doesn't work.
It's definitely widely used in Germany, where I work. I don't know how common it is in the US, though.
I often think about what makes medicine so different from aviation and your other examples, culture-wise. It's not like there's no safety culture at all in medicine, but clearly these kinds of structures are deployed to a much lower extent.
One major reason might be the far larger diversity of possible situations in medicine. It's possible to make a checklist for surgical safety because every surgery is similar, same to how every plane flight is similar. But if I think about, for example, harm due to adverse effects from medications, or missed abnormal values in blood tests, it feels very difficult to create a checklist to prevent those that would be specific enough to be useful, but also general enough to capture all important situations these might arise in.
In this sense, I think certain “low-hanging fruit” of safety culture improvements have already been captured in medicine. Apart from surgical safety, I can think of check lists for chemotherapy administration, for blood transfusions, for management of a severe allergic reaction, and other specific individual things. Pointing and vocalizing is also done in surgery, albeit in a less formal way. “Two sets of eyes” policies exist in e.g. pathology for more certainty in diagnosis of cancer.
Nevertheless there is clearly room to improve, as evidenced by the continuing occurrence of “never events” such as retained foreign bodies in surgery. There are certainly economic factors at play here as well: unlike in the free market, in the medical system there is often very little economic incentive for quality, and the same principle I mentioned before — of the immense diversity of possible situations — makes top-down regulation very tricky.
Maybe part of it is also that the potential harm from a retained foreign body is much lower than the potential harm from a plane crash. And maybe medical care is so much more common than plane flights that by base rate alone, mistakes in the former will be much more common. Yet I still think there is much that can be done, and I am unsure what exactly is preventing that from happening.
Yes but the major is the number of deaths. An incompetent surgeon can kill at most one person at a time. Besides, variance in surgery is much higher than in aviation.
(I think knots are cool, but I don't really know of motivating examples for why I would hypothetically need them.)
Of course it’s not every surgeon, but there are some butchers that out happens more with. It ended up being a repeat problem for my mother’s surgeon.
Or even some form of RFID tagging and a scan wand.
The flip side is "sorry, we didn't have enough surgeons available right now so we have to triage you", or, "sorry you can't afford the bill"
I'm sure in this particular situation the numbers benefit "don't leave surgery debris in the patient" but the more general point remains, there is some set of numbers (likely implausible) where it would flip the other way