The checklist

I know I blogged about this before and that it has been the subject of many many discussions – for those of you hanging around me – but if you have not read The Checklist from The New Yorker last year, then you need to head on over and give it a read. I am just saying if "something so simple can transform intensive care, what else can it do?".

I am a huge fan of checklists and every time I stop using them because I am too busy to make sure I create them, I regret it. My checklists work on the simple principle that you need to understand the problem you are solving and whom in your team needs to be involved. In times of crisis or when your servers go haywire, a checklist becomes a life saving device. It becomes how you execute things, it allows ordinary people to achieve the extraordinary and execute flawless complex procedures. So before you go anywhere: make your checklist, understand the "if" and "then". If x happens than y needs to follow. Checklists save lifes everyday, they will do wonder for your startup.

From The Checklist

Recently, I spoke to Markus Thalmann, the cardiac
surgeon on the team that saved the little Austrian girl who had
drowned, and learned that a checklist had been crucial to her survival.
Thalmann had worked for six years at the city hospital in Klagenfurt,
the small provincial capital in south Austria where the girl was
resuscitated. She was not the first person whom he and his colleagues
had tried to revive from cardiac arrest after hypothermia and
suffocation. They received between three and five such patients a year,
he estimated, mostly avalanche victims (Klagenfurt is surrounded by the
Alps), some of them drowning victims, and a few of them people
attempting suicide by taking a drug overdose and then wandering out
into the snowy forests to fall unconscious.

For a long time, he
said, no matter how hard the medical team tried, it had no survivors.
Most of the victims had gone without a pulse and oxygen for too long by
the time they were found. But some, he felt, still had a flicker of
viability in them, and each time the team failed to sustain it.

Speed was the chief difficulty. Success required having an array of
equipment and people at the ready—helicopter-rescue personnel, trauma
surgeons, an experienced cardiac anesthesiologist and surgeon,
bioengineering support staff, operating and critical-care nurses,
intensivists. Too often, someone or something was missing. So he and a
couple of colleagues made and distributed a checklist. In cases like
these, the checklist said, rescue teams were to tell the hospital to
prepare for possible cardiac bypass and rewarming. They were to call,
when possible, even before they arrived on the scene, as the
preparation time could be significant. The hospital would then work
down a list of people to be notified. They would have an operating room
set up and standing by.

The team had its first success with the checklist in place—the
rescue of the three-year-old girl. Not long afterward, Thalmann left to
take a job at a hospital in Vienna. The team, however, was able to make
at least two other such rescues, he said. In one case, a man was found
frozen and pulseless after a suicide attempt. In another, a mother and
her sixteen-year-old daughter were in an accident that sent them and
their car through a guardrail, over a cliff, and into a mountain river.
The mother died on impact; the daughter was trapped as the car rapidly
filled with icy water. She had been in cardiac and respiratory arrest
for a prolonged period of time when the rescue team arrived.

From that point onward, though, the system went like clockwork. By
the time the rescue team got to her and began CPR, the hospital had
been notified. The transport team got her there in minutes. The
surgical team took her straight to the operating room and crashed her
onto heart-lung bypass. One step went right after another. And, because
of the speed with which they did, she had a chance.

As the girl’s body slowly rewarmed, her heart came back. In the
I.C.U., a mechanical ventilator, fluids, and intravenous drugs kept her
going while the rest of her body recovered. The next day, the doctors
were able to remove her lines and tubes. The day after that, she was
sitting up in bed, ready to go home.

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