“Man is fallible, but maybe men are less so.”

By Jenny Cisneros 

 In everyday life we find ourselves doing the most repetitive, somewhat, mundane activities. However, there are those days in which we slip up and forget key steps to executing certain activities.  Atul Gawande, author of The Checklist Manifesto: A Guide to Get Things Right, describes how the sheer volume and complexity of knowledge people are expected to retain eventually gives way and is a major cause for common human errors. Human errors are often attributed to a number of factors such as, stressful circumstances, overlooking important but necessary steps or people just completely forget. Gawande provides insightful yet persuasive arguments for why people in any profession should consider implementing checklists.

Walmart to the Rescue?

 
In the summer of 2005, the unthinkable happened, Hurricane Katrina slammed into New Orleans. Dumping sheets of heavy rain on the city that caused the protection of the levees to breach, leaving parts of the city virtually under water. The aftermath of Hurricane Katrina still haunts those left behind during the natural disaster. Initially, the reports of what was really happening were vague. When the “command-and-control paradigm” collapsed in New Orleans, government officials were unsure who to turn to, to send aid. While all levels of government officials were halted by the destruction of Hurricane Katrina, the most unlikely of organizations stepped forward and took initiative to help the victims of this terrible disaster.  Although, the corporate giant Wal-Mart has been under major controversy and scrutiny because of the treatment of their employees, they stepped forward and lent a hand to those in need. While government officials were still scrambling around unsure who to blame or how to help, 48-hours after the Katrina made landfall, Wal-Mart store managers began distributing bottled waters, diapers, baby formula and much more to New Orleans residents. Corporate Wal-Mart officials maintained all forms of communication with every store that had been damaged during the storm, however, despite all the mayhem they left the solution of this complex situation to those who were in the midst of all the destruction. As the days trudged on, Wal-Mart employees found ways to coordinate with other stores and began setting mobile pharmacies and clinics that would  help and distribute medications to evacuees. In the end Wal-Mart provided New Orleans with a total of 2,498 truck loads of emergency supplies and donated about $3.5 million worth of Wal-Mart merchandise. 

Sometimes help can come from the most unlikely sources. The truth is that while FEMA was still figuring the logistics of how to help, a private organization stepped forward and allowed people from all levels of the corporate ladder make executive decisions. Gawande’s writes, “The lesson of this tale has been misunderstood. Some have argued that the episode proves that the private sector is better than the public sector in handling complex situations. But it isn’t...under conditions of complexity, not only are checklists a help, they are required for success” (Gawande, 2009, pgs. 78-79).  Although, Wal-Mart officials did not follow a formal checklist, as the days continued they managed to create one amongst all the chaos. People were able to strip themselves of their titles and make educated decisions that were for the greater good of the people. 

Agents of Change

In late 2006, Dr. Gawande was approached by the World Health Organization, to help organize member countries in a conference and try to find a solution to unsafe surgery practices. During a two-day conference in Geneva in January 2007, Dr. Gawande heard hundreds of stories of surgeries gone wrong. The list just went one and the results seemed grim. In the process of finding a simple solution, Dr. Gawande recalled a project conducted by the U.S. Centers for Disease and Control and project HOPE in Pakistan some years back. The death rates of children around Karachi, Pakistan were due to poor living conditions, water sources were contaminated by sewage and one in every ten children died of from diarrhea or acute respiratory infections. How do you reconstruct a society in a country where so many things have gone wrong? A public health worker from Nebraska provided a simple yet obvious solution to such a large problem. Stephen Luby persuaded his colleagues to supply cases of Safeguard antibacterial soap and just plain soap to the people of Karachi. Each family received approximately 4 bars a week for a whole year. Some families received antibacterial soaps and others received soaps with no antibacterial agent. Case workers encouraged families to use the soap to wash their bodies once a day, wash their hands doing their business, cleaned an infant or were about to prepare and eat food.  While the families were encouraged to use the soap daily, researchers found that during this time diarrhea among children fell 52 percent, pneumonia in children dropped 48 percent and bacterial skin infections dropped 35 percent. In the end the results spoke for themselves. Although some received soap without an antibacterial agent, the significance of that the soap provided was a major behavior change in the people of Karachi. As a result, researchers provided  Karachi villagers with the necessary information on how and when to use the soap. Luby’s deviant behavior led researchers to use the same methodology in places like Bangladesh and various countries in South Asia. For most Americans, soap is just another overlooked luxury that we take for granted. The solution had been there all along, it just took a deviant to point out the obvious solution. 

 A Checklist that saved a life

 
Throughout the text Gawande provides some of the most compelling arguments for using a checklist in any profession. He uses a number of examples where checklists have saved hundreds of lives during commercial flight crash or just one life during a routine surgical procedure. Although Gawande became well known as an acclaimed author of a New York Times Bestseller, he is best known as a general and endocrine surgeon at The Women’s Hospital in Boston and an associate professor at Harvard Medical School and the Harvard School of Public Health.  In the spring of 2007, Dr. Gawande decided to put these surgical checklist to use in his own operating rooms. A patient he had that spring was a fifty-three year old male who came in to have one of his adrenal glands removed because it had an unusual tumor growing inside. The adrenal glands are endocrine glands that sit on top of the kidneys. Tumors, like this patient’s, can be difficult to remove, but generally removed without complications. However, there was a slight but small possibility that if the main vessel that returns blood to the heart, the vena cava was torn during surgery, the consequences could be deadly. Feeling confident enough Dr. Gawande conducted the surgery laparoscopically. Much to his dismay, as he was about to remove the tumor completely, he made small tear in the vena cava.  As a result, the patient lost way too much blood in short time that sent him into a cardiac arrest. Before starting the surgery, Dr. Gawande and his surgical staff reviewed their surgery checklist, that included having four extra units of blood on hand in case of an emergency.  During the mayhem, all members of the surgical staff remained calm and level headed, followed the proper procedures and were able to resuscitate the patient. However, while the patient’s pressure had dropped so low for a short period of time, it damaged his left optic nerve, leaving him blind in one eye. Although Dr. Gawande’s patient survived the near fatal experience, Dr. Gawande was grateful for having his checklist. This particular experience served as a lesson learned that although things may never go according to plan, we can take the necessary steps to avert complete disaster and in order to avert disasters, use a checklist to jog your memory.