big different from small change

It seems like such a simple change. Yet asking people to introduce themselves and describe their function in the operating theater before an operation starts turns out to have a significant impact on the operation's outcome. That is just one of the findings in a recent study by Atul Gawande (the study includes more than a dozen other authors as well), just published in the New England Journal of Medicine, that has created quite a buzz in the healthcare community.

That requirement, along with 18 others, forms part of a checklist adopted by surgical teams at eight hospitals. Over the course of the year the teams saw their death rates fall by 40% and their rate of complications by almost a third. The researchers weren't able to attribute the success to any one of the items on the checklist and concluded that it was the behavioral changes occasioned by the checklist (and the fact that they were part of an experiment) that improved the outcomes of the operations conducted by the team.

The study's findings echo an article published in the September 2005 issue of Harvard Business Review. In his McKinsey Award-winning paper "Fixing Healthcare from the Inside, Today," operations expert Steven J. Spear presents the results of a series of experiments conducted at a hospitals in Boston, Pittsburgh, Salt Lake City, Seattle, and elsewhere. Like the Gawande study, these projects show just how a great an impact a combination of relatively small changes in procedure can have on the quality and safety of healthcare provision.

One Pennsylvania hospital, for example, was able to reduce infections caused by inserting catheters into a patient's bloodstream from 37 occurrences to just six. Deaths from infections fell from 19 to one. The hospital also saved $1.4 million a year in the direct costs related to treating the infections. Achieving all this required virtually no investment, just six simple changes in procedure, such as requiring staff to completely remove faulty catheters and insert new ones rather than attempt to fix the faulty catheter.

But Spear does more than just present a set of recommended procedural changes. The real contribution of this paper is that it demonstrates how healthcare service providers can discover the sort of improvements that he describes for themselves - an impressive demonstration of the old saw about how teaching a man to fish is better than just giving him the fish.