Today we heard from Kathy Masters about the basics of Six Sigma, a statistical system designed to improve efficiency of outputs by minimizing errors. We focused on measuring these outputs, the “M” in the DMAIC. One of the principal ways to measure is the use of checklists in medicine. Dr. Tsai, a pediatric cardiothoracic surgeon, talked about how checklists in the OR have helped to decrease the rate of surgical site infections.
- However, why haven’t checklists been adopted in medicine as they have in the automobile construction industry and world of aviation? What are ways for them to gain widespread acceptance?
Checklists also have drawbacks, as Dr. Tsai alluded to in his comment about having so many checklists that you need checklists to remember all the checklists. Many of the interpersonal aspects of healthcare, like establishing a rapport with a patient, being considerate of cultural and religious concerns and caring for a person’s emotional needs are not readily exportable to a checklist. It is important to recognize that checklists have both benefits and limitations and they must be executed appropriately.
Kathy Luther also mentioned how checklists can be adopted in primary care in the treatment of diabetes. Measuring HbA1c, HDL, and LDL should be done annually for diabetic patients, yet this is not being done. Does a checklist solve this problem? Blue Cross Blue Shield recently started a program called Bridges to Excellence, where physicians are financially rewarded for following guidelines for diabetic and cardiac care.
- Are checklists an effective, accurate, and fair way to measure quality improvement in the primary care clinic?
We also discussed the proper implementation of a checklist in an operating room setting. Dr. Tsai mentioned that in Memorial Hermann ER’s the checklist is done by the surgeon, while other operating rooms throughout the country will use residents, fellows, and nurses to run the checklist.
- Who should be in charge of the checklist? Also, continuing on yesterday’s post on technologies involved in process maps, what technologies could be implemented to improve usage? Are there ways to integrate the checklist with the electronic health records?
