What I learnt this week: Safe checklists versus speedy check-ins #WILTW

This is the 45th WILTW

The tragic events surrounding the crash of 4U 9425 demonstrate the difficulty in counter-acting every possible cause of harm or safety failure. There are processes though, both in the airline and health care industries, which are designed to mitigate the chance of injury and death. Checklists are an example common to both sectors (appreciating in healthcare checklists have both supporters and detractors). Most other mechanisms are unique to each industry. I personally find it odd there appears to be variation about the different security checks employed at different airports (shoes on or off, pressure versus x-ray scanners etc.) but the need for such a check has inherent face validity.

I flew to Belfast this week to give a talk as part of the “Berwick” series so my mind was already on processes and cultures. I had arrived at the airport later than I had intended but still with reasonable time to pass through security and get to my gate. However the delay, even with an express security pass, was considerable and I must admit I was getting increasingly nervous even before my bag was picked out as having a problem. The delays were not due to volume of people. They were due, dependant on your view point, to either the diligence of the staff or the absence of any haste. There was absolutely no urgency at all. It was painstaking to watch. You could see people becoming increasingly frustrated as the pre-scan person would carefully manoeuvre items around the boxes before pushing them through the machine. The person reading the x-rays would move backwards and forwards on each and every item. The man handling those which flagged as at risk would ponderously remove each and every item from the bags he was reviewing. It was painful to experience with the frustration clearly exacerbated by my being in a rush.


Emergency departments also have to process lots of people but equally need to make sure each person has a thorough assessment. I take on board the fact that in the medical environment people may suffer harm if they aren’t ‘processed’ quickly enough and one patients actions are unlikely to affect any others if that process is inadequate. I was discussing the potential analogy with Gavin Lavery on the drive to the conference venue. He raised an interesting point about how in healthcare, in order to meet an ever increasing demand, the staff just ‘find a way’. Going beyond capacity to find beds or being able to review more patients in less time during peak periods. The benefits of this are obvious but it creates a paradigm where you don’t always follow the ‘manual’ at all times. The checklist connudrum persists in part because staff want flexibility in the way they work. The challenge in healthcare is maintaining safety during flexible approaches.

I wouldn’t be able to work a security officer in an airport. I am not sure I would be able to maintain the air of someone whose desire for safety completely override any patient experience, day in day out, regardless of queues and the relentless stares of the public. But perhaps on a busy shift I’ll remember that just working that bit harder, or cutting that small corner, is not really what a ‘safe’ system should do.

What have you learnt this week #WILTW

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