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Checklists save money but adopted at glacial pace

For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care.

In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and infections, along with significant improvements across many care standards for a wide range of surgeries that were done using the tool. And yet the take-up rate on this tool — which is so simple it fits on one single sheet of paper — is very slow to occur.

On some level, I just don’t get it. There are task forces,
committees, commissions, and councils all over America that are working
on the cost/quality problem — and here we are — with a proven, simple
tool that reduces cost and variation and improves quality and safety —
and we can’t get it adopted. The “advocates” don’t call for the
adoption of checklist tools. The policy making community isn’t
demanding them. Health plans, including this one, have been slow to
move, and so has the provider community. Why?

The truth is, I don’t know why, but I suspect the tool is simply too
simple. People in health care — and I include myself and my colleagues
in this category — think everything in health care is complex, so when
someone comes along with a simple tool that does all the things a
checklist can do, we simply don’t buy it — literally or figuratively.
This bums me out. Maybe some smart policymaker will come along and grab
the bull by the horn and make it happen through regulation or
legislation. Then we can stop talking about what we’d like to do about
cost and quality, and maybe talk about what we did.

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