Thoughts on the checklist study

I’ve been bothered a bit by the study that Bill highlighted yesterday. One of the reasons is that I think it ignores real issues of implementation. There are big differences in efficacy versus effectiveness. Telling a whole bunch of hospitals to “do something” and then not providing resources or infrastructure to do it simply cannot get the same result as an effort that does provide these things. It would like telling lots of hospitals to “be better” and expect the same result as intense interventions to improve quality.

We shouldn’t minimize the sophistication of checklists. They still involve a lot of work. They involve culture change, process change, and a shared commitment to better quality. It’s not the piece of paper that’s important – it’s everything that goes with it.

In this study, that seems far from assured.

Moreover, I’m not sure this study was powered the way it should be. How much of a mortality reduction did they expect to see in such a short period of time? Were these procedures ones with high mortality that could be influenced greatly by checklists? I hate to sound the “power problem” again, but I’m just not sure. I need to do further calculations.


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