Atul Gawande

  • Aired:  01/05/11
  •  | Views: 29,143

Atul Gawande explains how checklists make flying, surgery and Van Halen shows safer. (6:07)

EVERYBODY.

MY GUEST TONIGHT HAS WRITTEN A

BOOK ABOUT THE POWER OF LISTS.

IT WORKS FOR SANTA.

PLEASE WELCOME DR. ATUL GAWANDE.

( CHEERS AND APPLAUSE )

THANK YOU.

DR. GAWANDE, THANKS SO MUCH FOR

COMING ON.

>> GLAD TO BE HERE.

>> Stephen: ALL RIGHT, SIR.

YOU HAVE A BOOK OUT IN PAPERBACK

NOW.

IT'S CALLED THE CHECKLIST

MANIFESTO.

HOW TO GET THINGS RIGHT.

HOW DOES... ISN'T A CHECKLIST

FOR PEOPLE WHO DON'T KNOW HOW TO

DO THINGS RIGHT?

IT'S LIKE A RECIPE BOOK.

>> EXACTLY.

PEOPLE HAVE THOUGHT THAT

CHECKLISTS WERE ONLY ABOUT THE

LOWEST PEOPLE ON THE TOTEM POLE,

BUT IN A WORLD WHERE WE ARE

FACED WITH ENORMOUS COMPLEXITY,

WE ASK ORDINARY PEOPLE TO DO

EXTRAORDINARY THINGS, FLY

AIRPLANE, BUILD SKYSCRAPERS, DO

OPERATIONS.

>> Stephen: HOST A SHOW.

>> HOST A SHOW.

>> Stephen: SAID IT COULDN'T

BE DONE.

>> WE ARE FAILING BECAUSE OF

INABILITY TO MEET THE BASICS.

>> Stephen: HOW ARE WE

FAILING?

WE'RE AMERICA, SIR.

AMERICANS DON'T NEED CHECKLISTS.

WE FREE BALL IT.

OKAY.

ALL RIGHT.

CHECK ONE, SHOW UP TO WORK.

TWO, BE AMERICAN.

OKAY.

GREATEST WORKERS IN THE WORLD.

YOU'RE A DOCTOR, RIGHT?

YOU'RE A SURGEON.

YOU CUT INTO PEOPLE, RIGHT?

DO YOU USE CHECKLISTS?

WOULD YOU USE A CHECK LIST?

>> I BEGAN USING A CHECKLIST IN

THE LAST COUPLE YEARS.

>> Stephen: WHAT DO YOU DO

WITH THE CHECKLIST?

>> WE WORKED WITH BOEING.

>> Stephen: YOU WORKED WITH

BOEING?

WHY IS THAT NECESSARY, WHY

BOEING?

>> BECAUSE THEY MAKE OVER 100

CHECK LISTS A YEAR TO DEAL WITH

CRASHING AIRPLANES AND HOW TO

MAKE THEM WORK.

>> Stephen: HIT GROUND.

>> RIGHT.

YES.

OKAY, FAILING AIRPLANES.

>> Stephen: FAILING AIRPLANES.

>> AND SO WE WORK WITH THEM AND

MAY SHOW US HOW THE MAKE IT WITH

WE COULD USE IT IN CRISIS

SITUATIONS.

WE MADE A TWO-LIST CHECKLIST.

MAKE SURE EVERYONE IN THE ROOM

KNOWS EACH OTHER'S NAME.

>> Stephen: SOMEBODY WOULD

JUST SNEAK INTO SURGERY, BECAUSE

THEY WANT THE TAKE A COUPLE

STAB, SEE HOW IT FEELS?

>> THE BACKLASH TOE EVEN THE

IDEAS IS OF COURSE WE DO THAT.

WE PUT THE CHECK WILLIST IN.

IN EVERY HOSPITAL WE PUT IT IN,

IT REDUCED COMPLICATIONS AND

DEATHS.

ON AVERAGE BY MORE THAN

ONE-THIRD.

18 COUNTRIES HAVE ADOPTED IT,

INCLUDING THE NEATHERLANDS WHERE

THEY PUBLISHED THEIR DEATH RATE

WENT DOWN 50%.

>> Stephen: IN THE NEW

NEATHERLANDS, NUMBER ONE IS PUT

OUT YOUR JOINT.

I DON'T KNOW IF I WANT A SURGEON

APPROACHING SURGERY THE WAY I

APPROACH LOVE MAKING.

YOU KNOW, I HAVE A RIGHT HERE,

BY THE WAY.

IS IT JUST FOR... HAVE YOU MOVED

THIS INTO OTHER FIELDS?

>> IN FACT, IT HAS COME FROM

OTHER FIELDS.

IT STARTED WITH A BRILLIANT IDEA

OF AN ANESTHESIOLOGIST AT JOB

JOHNS HOPKINS WHO BROUGHT

CHECKLISTS INTO INTENSIVE CARE

UNITS, DID YOU WASH YOUR HAND,

DID YOU PUT ON GOVERNORS AND HAT

AND MASK AND A STERILE GOWN

BEFORE YOU TRY TO PUT A CENTRAL

LINE IN A PATIENT?

IT REDUCES INFECTIONS IN THE

STATE OF MICHIGAN BY TWO-THIRDS.

>> Stephen: ISN'T THIS GOING

TO MAKE EVERYBODY ABLE ALL THE

TIME.

IF WE NEVER MAKE MISTAKES, WE

CAN NEVER LEARN FROM OUR

MISTAKES, CORRECT?

IT IS NOT CORRECT?

SO YOU DON'T WANT PEOPLE TO

LEARN.

YOU DON'T WANT PEOPLE TO LEARN

FROM THEIR MISTAKES.

YOU'RE A TERRIBLE TEACHER.

( LAUGHTER )

DON'T YOU AGREE?

THERE'S LEARNING... DO YOU AGREE

YOU LEARN FROM YOUR MISTAKES.

>> YOU LEARN FROM YOUR MISTAKES.

>> Stephen: OKAY.

HOLD ON.

I WANT THE CHECK OFF THIS I

NAILED YOU.

GOT YOU RIGHT THERE.

IS THERE ANY PLAYING THIS

DOESN'T APPLY?

WHAT ABOUT THE ARTS.

AN ARTIST HAS TO BE SPONTANEOUS

AND FREE WHEELING AND LET THE

MUSIC MOVE HIM OR HER.

WOULD YOU APPLY THIS TO THAT?

>> I TELL THE STORY OF DAVID LEE

ROTH.

VAN HALEN.

>> Stephen: I TELL SOME

STORIES WITH DAVID LEE ROTH,

TOO, BY THE WAY.

>> VAN HALEN WOULD HAVE A

CONNIPTION FIT IF YOU HAD BROWN

M&Ms IN A BOWL IN THE DRESSING

ROOM.

THE REAL STORY BEHIND IT IS

DAVID LEE ROTH WOULD... THE

WHOLE BAND WOULD BRING THEIR

WHOLE STAGE SHOW INTO LITTLE

TOWNS ACROSS AMERICA THAT NEVER

HAD THIS THREE-TIER STAGE SET ON

THEIR BASKETBALL ARENA AND HAD A

CHECKLIST.

ON THE MIDDLE OF THE CHECK LIST,

NO BROWN M&Ms IN THE DRESSING

ROOM, AND IF THEY DIDN'T RUN

THROUGH THE CHECKLIST, THEN THE

STAGE WOULD FALL APART AND KILL

SOMEBODY SOME THEY WOULD WALK

INTO THE DRESSING ROOM, SEE

BROWN M&Ms, THEY KNOW THE SHOW

COULDN'T GO.

THEY CANCELED THE SHOW.

THAT WAS THE CHECK LIST.

>> Stephen: NOT BECAUSE THEY

WERE COMPLETE PRIMA DONNAS BUT

BECAUSE THEY USED THE CHECK LIST

AS SOME SORT OF CANARY IN A COAL

MINE TO SEE WHETHER SOMEBODY WAS

PAYING ATTENTION.

>> THEN THE BEAUTY IS YOU COULD

THEN BE A COMPLETE PRIMA DONNA,

THROW THINGS AROUND, GET IN THE

PAPERS WHEN IN REALITY HE WAS

BEING EXTREMELY CAREFUL.

>> Stephen: AND HOW LONG DID

YOU THINK IT TOOK HIM TO COME UP

WITH THIS RASH NAL -- RATIONAL?

WHAT'S NEXT?

IS THERE ANY PLACE LEFT WHERE

KIDS AREN'T?

>> I THINK WE NEED TO TEACH KIDS

TO MAKE CHECKLISTS AND HOW TO

HANDLE COMPLEXITY DURING

ORDINARY LIFE.

>> Stephen: YOU'RE A TERRIBLE

PERSON.

WHY DO YOU WANT TO MAKE CHILDREN

ANAL?

( LAUGHTER )

>> WHEN WE THINK ABOUT WHAT THEY

HAVE TO GROW UP AND DEAL WITH,

IT IS TO BE THE KIND OF PEOPLE

IN THE WORLD WHO CAN MANAGE

EVERYTHING FROM SURGERY THE

FLYING PLANES.

>> Stephen: OKAY.

BUT NEXT TIME IN SURGERY I LOOK

UP AND I SEE A KID, I'M GOING TO

BE MAD AT YOU.

DR. GAWANDE, THANK YOU SO MUCH.

ATUL GAWANDE.

THE BOOK IS "THE CHECK WILL

MANIFESTO."

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