2.02.2009

Performance Data is Key to Convincing Skeptical Doctors

There was a lot of coverage recently – as there should be – reporting on a study that found a simple checklist used at the time of surgeries can significantly reduce the rates of deaths and complications.


The study was published in the New England Journal of Medicine. According to an article in The Washington Post,


In the one-year pilot study involving 7,600 patients, the hospitals saw the rate of serious complications fall from 11 percent to 7 percent. Inpatient deaths declined by more than 40 percent overall, with the most drastic reductions occurring in hospitals with fewer resources.


Very few U.S. hospitals currently use such a checklist


The checklist covers many points, from the patient’s allergies to confirming equipment has been sterilized to assessing potential problems.. The point is that surgery is complex, and doctors should not assume they will remember everything that must be addressed.


The problem is, doctors do assume they remember. And for me, the most interesting part of the Post article is its discussion of how you get more doctors to adopt the checklist.


The major barrier to widespread adoption is physician attitudes, several experts said.

"If you ask surgeons, they'll say, 'Oh, we do this stuff,' " said Atul Gawande, a Boston physician who led the study.. He himself was skeptical that the checklist would affect the eight to 10 operations he performs each week.


"I don't get through a week where it has not caught something," he said. Running through the list reminded him of one patient's allergy and prompted his anesthesiologist to prepare for an unusually large amount of blood loss, which could have been fatal.


One of the most effective ways to market the checklist to doctors is to collect data on their performance, said David Flum, a surgeon at the University of Washington Medical Center, which took part in the study. Once they see how they stack up against their peers, physicians are quick to adapt, he said.


As in so many areas of process improvement, the proof is in the data. That is how you win the hearts and minds of skeptical people.

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