Academic journal article The Hastings Center Report

Getting Right with Guidelines

Academic journal article The Hastings Center Report

Getting Right with Guidelines

Article excerpt

Near the beginning of our three-year project to revise and update the 1987 Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying--a.k.a. "The Hastings Center Guidelines"--one of our working group members, a physician, described our audience as "good docs in bad systems." I don't think this physician was referring to "systems" as institutions, or that nebulous entity, "the health care system." All good docs (and good nurses, and so on) work inside systems, all the time. A patient care team is a system. A process for conducting ethics consultations, or for handing off responsibility for patient care at the end of a shift, is a system. Theorists and scientists alike remind us that a system will deliver the results it has been designed to deliver. And if a system consistently delivers bad results--or inconsistently delivers good results--it's a bad system.

I was reminded of that physician's remark when I read an essay published last August 8th in The Lancet, entitled "Reality Check for Checklists." The essay notes how quickly the complex patient safety initiative developed by Peter J. Pronovost to reduce line infections in the intensive care unit had been reduced to the myth of the "simple checklist." According to it, the checklist is the perfect system: just pull it out of your pocket, in any setting, follow it step by step, and, presto, no infections. There is a grain of truth in this myth, as Pronovost has the evidence to support the intervention. However, the authors of this essay--who include Pronovost himself, as well as medical sociologist Charles L. Bosk--point out that swallowing the myth pushes aside the real problem of how human beings, at every level in a hierarchy, adapt to, or reject, the use of tools such as checklists. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.