Fire in the Operating Room

Atul Gawande describes an amazing experiment that dramatically improved surgery results in a wide variety of hospitals in many different countries. The results showed substantial improvements including reductions in deaths, major complications, and return visits to the hospital. The truly amazing part is the intervention was so simple. They got surgery teams to use a safety checklist.

Now, of course, BCBA’s are no strangers to checklists. Still, I think there are huge lessons that behavior analysts can learn from this experiment. When designing the checklist, the team considered all kinds of possibilities to determine what should and should not go on the checklist. One of the things that the team considered were fires in operating rooms. When a fire breaks out during an operation, it is extremely dangerous, can cause serious injury, and the hospital is liable for damages. Considering how serious that problem can be, the team made a fascinating decision – they decided against including any checklist items to prevent fires!

Why would they make a decision like that? Simple. Their focus was to make the checklist practical. Preventing fires would substantially increase the checklist length. They strongly suspected that adding this to the checklist might decrease their effectiveness by making surgeons much less likely to use it. In addition, although fires happen, they are incredibly rare. Compared to the other very common problems they were trying to prevent (infections, bleeding, and unsafe anesthesia), they decided fires weren’t worth addressing.

When we select what changes to make, it is important to realize that it is possible to make anything sound extremely important when you consider it isolation or hear a dramatic story, like a fire during surgery. Sure, sometimes the problem is extremely important. Both the staff and the clients have limited time and attention. Working on too much at the same time is a sure way to fail. When we consider all of the client needs, is this really the most important thing we should be addressing?

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.