It’s Not About The Box Improving Care at Group Health with People, Process and Technology

July 28, 2011

A Different Kind of Checklist Experience

Filed under: Safety — Matt Handley @ 3:25 pm

I think that personal experiences reinforce theoretical concepts much more powerfully than readings, lectures or the stories of others. No matter how many great anecdotes Atul Gwande included in his excellent book “The Checklist Manifesto” , a personal experience will always drive home the point more effectively.

My checklist experience wasn’t relating to a medical adventure – I did not experience the use of a checklist associated with a medical procedure.   My checklist experience was a part of a family adventure.

My daughters have wanted to go bungee jumping since they watched me bungee jump in New Zealand many years ago. This summer my youngest turned 18, and we decided that the best celebration would be to take the family bungee jumping (with my wife just watching, the sensible one). We went to a great site in southern Washington state and had a marvelous experience there.  A 191 foot drop over a small creek.   The crew there does everything right. The roles and responsibilities of every one on the team are clearly understood, the check list for harness and attachment to the bungee is independently checked by 2 different crew members before you’re ready to jump, and then double checked again prior to the jump. They are unabashed about calling out the specific items they’re checking, naming and touching and testing each part of the harness and attachment.

My daughters had a great time, each jumping twice, first facing forward and and then facing backwards.  Weighing considerably more than my daughters, I followed after the bungee cord was switched to one of more considerable heft.  They went through the checklist with the same rigor, and I had a great time leaping far out on the first jump.  There are two remarkable feelings when you bungee jump.  The first is the feeling of having your adrenal glands become the size of raisins – lots of adrenaline. The second is when the body starts to slow and your mind recognizes that you are not going to hit the bottom and you bounce back up, at this location probably 70-100 feet back up.  It’s a marvelous feeling.   After I had been winched back up after the first jump, they asked me to step over the railing rather than do my second jump.   The supervisor had heard something that might indicate a problem.   They ran through everything again, including checking through every bit of the bungee cords to make sure that things were sound.  I was surprised to find that this interruption was reassuring rather than worrisome.   Nothing was wrong with the bungee or the attachments, but because someone had heard something that might have indicated a problem they stopped the process and rechecked the equipment completely before proceeding.    Then back to play – I got to do the backwards jump, which was pretty incredible.

It was an interesting experience from a safety perspective.   While there were some jokes made about adventures sports and the risks we were taking, it was clear from their processes that this was really the illusion of danger, and all of the activities of the crew were organized around safety.   No one thought that the participants  needed to be insulated from the crew’s concern about safety, and they led with that (although they did accompany it with a healthy dose of entertainment).  Substitute care and concern for entertainment, and that’s a great model for us in medicine.

I can’t post about bungee jumping without adding two photos of the adventure.  The leap out, and the moment of unweighting as you are heading back up after the first “bounce”.

The Jump

The Happiness of Floating

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