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Why a Checklist by Steve Gutzman

There was a time in the field of medicine when it was possible to know everything that there was to know.  Lewis Thomas writes in his book The Youngest Science that before the discovery of penicillin in 1939 doctors kept busy by trying to figure out whether you had a condition they could do something about.  Medicine back then was cheap but largely ineffective.

Fast forward to 2012 where there are more than 4,000 different medical and surgical procedures and more than 6,000 available prescription drugs, and it has become impossible for one person to know everything.  The challenge has gone way beyond more training, more specialization, and more technology – today the challenge is complexity and making everything work together in a system.  Having great components is not enough.

While the volume of surgery has risen dramatically (there were an estimated 234 million surgeries in 2011), safety has not.  In 2007, the World Health Organization (WHO) funded a project to reduce death and complications in surgery.  The WHO chose eight hospitals from different cities (Toronto, Seattle, Ifakara, New Delhi, Auckland, Amman, and London), and with help from a Boeing safety engineer and Harvard Medical School, a simple 19-point checklist was developed and used in 3,955 surgeries.  The result was a 35% reduction in surgical complications and a 47% reduction in surgical deaths.

What is a checklist?  A checklist is a tool to make an expert better.  It is a reminder of the key things that get forgotten or missed.  A checklist does not tell you how to do the surgery, but it does present a sequence of questions that must be answered in order to ensure that the surgery is a success.  For example, in the medical checklist mentioned above, prior to incision, members of the surgical team were asked to “confirm that team members have introduced themselves by name and role” followed by “confirm the patient’s name, procedure, and where the incisions will be made.”  Pretty basic stuff, but with so much specialization in the modern hospital people often do not know the other person behind the mask or that person’s role.  And when a surgeon is prepping for six surgeries in one day, it is entirely possible that the left knee gets confused with the right knee.

Fortunately – with a few exceptions – most of our technology procurements do not have life-or-death implications, but contracting and implementing a mission-critical, 24/7, multi-continent, multiplatform, support application in “the cloud” can be as complex as any surgery.

From the vendor side, checklists play a key part in determining where, when, and how vendors commit their limited resources.  The well-trained companies have developed checklists of questions pertaining to market research, industry ratios, needs awareness, ROI, and personality profiling, to name a few.  The vendors use these checklists in role plays before the call and curbside reviews after the call, with the sum of these efforts designed to help them determine whether you are “qualified.”

Maybe now would be a good time to review your procurement and vendor management checklists.  For starters, has everyone on your team been introduced and does everyone know their role?  After all, 47% is too big a number to ignore.

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