Avoid deadly mistakes with a checklist, say Edward Miles and Jonathan Bloor

On 15 January 2009, 155 lives were saved by a checklist. Minutes after takeoff from New York’s LaGuardia Airport, US Airways flight 1549 was forced to ditch in the Hudson River.The captain later said a combination of luck, team work, and protocol had saved the lives of everyone on board.

The same day, the National Patient Safety Agency launched a checklist of its own. A new alert was to be issued, mandating the adoption of a modified WHO safer surgery checklist in operating theatres across England and Wales.

In his manifesto, endocrine surgeon Atul Gawande builds an argument for adopting a checklist culture in medicine. A recurring theme of Gawande’s thesis is of consistent human fallibility in the face of impossibly complex situations. He argues that modern medicine has evolved to the point of such complexity that simple life saving steps can often be missed by highly trained professionals focusing on the more difficult tasks at hand. Enter the checklist.

Checklists allow healthcare professionals to concentrate on the complexities of their roles. They facilitate better communication and they protect patients. Critics suggest checklists are an affront to individual professional autonomy, but Gawande counters that such beliefs might be a source of the errors checklists prevent.

This book is a must-read for anyone eager to provide safer care to patients. It implicitly challenges us to apply a checklist mentality to every facet of our own medical practices. While they may not be high-tech, every once in a while a checklist saves a life.

Jonathan Bloor is research fellow at University Hospitals Bristol Foundation Trust and co-founder of Doctor Communication Solutions. Edward Miles is a final year student doctor at Bristol University.

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