How to avoid mistakes in surgery Horizon 22 March BBC 2
The programme itself was very well presented but left the biggest question unanswered: If the evidence for using WHO Safer Surgery checklists is so compelling and use has been mandated, why do so many clinicians still refuse to use it? We are currently engaged by three Trusts that have problems with compliance with use of the checklist. They are not alone.
I ran three courses for doctors of various specialties this week gone with about 50 doctors in total. Each of those courses had at least one who expressed reluctance to use the WHO checklist, at least at first. In a way you cannot blame them. If their Trust introduced the checklist by email, as so many did, can you wonder at it?
Treat people like children and they may just act like them.
We find that treating healthcare professionals appropriately, listening to their concerns and worries gets buy-in. Also explaining what checklists are for, how to use them and particularly what can happen if they are used but not correctly can produce greater willingness to comply.
In aviation the Spanair MD-80 crash at Madrid in August 2008 resulted ultimately from the crew not performing the pre-take-off checks correctly. The flaps were not set and the result was a disaster that killed 154 passengers and crew. http://www.fomento.gob.es/NR/rdonlyres/EC47A855-B098-409E-B4C8-9A6DD0D0969F/107087/2008_032_A_ENG.pdf
Similarly the Air Florida crash into the Potomac river in Washington DC in January 1982 was caused by incorrect checklist usage – the engine anti-ice was not selected on in severe winter weather. The engine intake probes were iced resulting in an incorrect (overreading) power indication. The aircraft accelerated too slowly, failed to get airborne and crashed into the bridge and the river.
That’s the issue for aircrew, if they screw up there is a good chance they will die. That tends to get their attention.