No sooner had I posted a discussion of surgical checklists – in which I noted the reduction in commercial aircraft accidents – than the news came across that a USAir flight out of LaGuardia had set down in the Hudson River.
The good news, of course, is that everyone got off alive.
According to various reports, the pilots did start working through a three page landing checklist, something that usually starts at 30,000 feet, not 3,000 feet. Apparently, there was one switch that was not thrown, which would have sealed off the outside vents, which would have prevented water from coming in (the plane did not sink in the end).
So, in a true crisis, with minutes to go before coming down – somewhere – the pilot and copilot worked through the checklist. The big decision was where to land, and the captain had few choices and could really only go for one. If he dallied, changing direction from one option to another, he would have lost valuable time and altitude needed to reach another option. By reports, he quickly chose the Hudson River as the best option for all concerned – including the hundreds of thousands who the plane passed over.
We’ll know more of the details as the flight recorder transcripts are released. Let me offer this: what the checklist does is impose a tight discipline to work through a number of tasks that must be completed, many times in sequence, prior to landing. In this case, the landing gear were not lowered, as that would have caused the plane to flip end over end.
But here’s the takeway:
The WHO project looked at a 19 item checklist, not three pages. Checklists help to insure that important steps and sequences are taken. Checklists represents planning – someone has thought through the specific steps necessary to land a plane. With so many steps involved, a slip is possible, but the conseuqences would be devastating. Cockpits crews are constantly changing, so standardized procedurs are an absolute necessity to insure that a complex process, one that requires two people (for take off and landing), will be completed correctly.
Surgical procedures are a mix of the standardized and the spontaneous. The significant drop in surgical problems using the checklist begs for others to work through and develop standardized protocols. Checklists work particularly well when multiple people are involved in accomplishing a focused goal. Preventive care visits may be ripe for more delegation of tasks, freeing the physician to go on to another patient.
Improved – and proven – outcomes are the ultimate goal of much of the work we will see in health care over the next several years. Take a look at the WHO checklist – it’s pretty broad based and generic. It’s more about making sure that everyone has been introduced, knows what their role is, reviewed the procedure and plan, reviewed if there are anticipated problems, and then check out at the end.