The VA study: Surgery Checklists Saving Lives is the kind of stuff that toolheads stand up and say, “see how tools work.”  It is a false premise that will have hospitals running around implementing checklists to save lives.

If only saving lives were that easy.  It is the type of headline that leaves systems thinkers shaking their heads.

In as much as there may (or may not) be a place for checklists.  The reduction from a 17/1000 to a 14/1000 death to surgery ratio (besides bringing up statistical questions) doesn’t set the thinking on how to eliminate the next 14 deaths.  The copying of tools does not promote the next new thinking needed to solve new or other problems.

Improvement is  a function of changing our thinking . . . not standardization as a place to begin improvement.  The lack of understanding this creates an inability to achieve sustainable and continual improvement.

Checklists have been around for a long time.  The VA hospitals are not the first to try them – believe it or not.  Unless we change thinking we fall into a hazardous trap of thinking that improvement is just about tools and implementing things like checklists.  This is dangerous as hospitals wait for the next discovery rather than seeking to solve problems from the minds of their own workers.

Implementing checklists may have a worse effect in a hospital that has a poor work design and command and control thinking.  Then we will be reading about how checklists kill patients.

If hospitals are to improve the work the need to start with “check,” not checklists.  Understanding their hospital as a system from customer purpose.  A normative approach will help change the thinking that created the problem in the first place buy understanding the “what and why” of current performance.

A redesign of the work will follow and it may find a different and better approach than checklists.  As improvement is emergent from the work, not from tools.  The checklist tools will stifle innovation as copying usually does.

There is never a bad time to begin to change thinking and redesign a system.  Today’s problems require more than checklist thinking . . . they require systems thinking.

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Tripp Babbitt is a columnist (Quality Digest and IQPC), speaker, and consultant to private and public service industry.