The Conservatives shadow Health Secretary, Andrew Lansley, was yesterday widely quoted as codemning the governments health “targets” regime for forcing staff to “focus on ticking boxes not patients.” (FT 8th Mar 10).
We’ll leave aside why anyone would want to tick patients, and concentrate on Mr Lansely’s opposition to ‘ticking boxes’. He obviously has not read the latest book by US surgeon and best-selling author Atul Gawande, “The Checklist Manifesto”. Dr Gawande makes a simple point very well: ticking boxes can save lives. Using examples from airlines and building, he shows how well designed checklists help reduce complexity, put in vital ‘reality checks’ and generally supplement professional expertise without replacing it.
[‘The Checklist Manifesto’ sounds unfortunately trite and like so many other ‘snake-oil’ solutions to complex problems – but reading Atul Gawande’s book quickly dispels that first impression.]
For Mr Lansely, riding on the popular antipathy to “the audit society”, checklists are just a bureaucratic imposition. We should instead ‘trust the professionals’. But as Dr Gawande points out, in medicine the professional get it wrong – causing unnecessary infections, complications and deaths. Not all the time, not even in a majority of cases, but even a small minority of errors can result – given the volume of medical activity these days – in significant extra illness and loss of life. And hard research evidence shows that check-lists, designed well and used properly, can help prevent a significant proportion of these errors far more effectively and efficiently than any other change (e.g. extra training). Mr Lansely, and the many others like him who condemn “box ticking”, should look at the evidence before they pronounce quite so glibly.
[For a good short review of Gawande’s book see Raphael Behr in the Observer]