Martin McShane: Tick

Martin McShane

In 2008 the National Patient Safety Agency set a deadline for acute trusts to implement the safer surgery checklist. By? Well, now actually. If you don’t know what the checklist is about it then read Atul Gawande’s latest book or a review of it. It would appear from a survey done by the Patient Safety First campaign some acute trusts haven’t managed to get it implemented.

When I first heard about the checklist a couple of years ago I rang an old friend who is a surgeon. I asked him what he thought of the idea. “Yes, they made us pilot it. I have to go through this daft American process of talking to my anaesthetist by first name to check all the things we do for a patient have been done.” His sarcasm rolled across the network. “So you think it’s a load of tosh?” “No! We discovered we had a 40% error rate in the first week. I’ve now implemented it in my private practice.” I had forgotten all the revues we did together and how he loved a good punchline.

The Patient Safety First campaign exhorts Trusts to monitor implementation of the checklist. I also noticed that commissioners weren’t mentioned. Do they have a role? I think so. I went and caught up with our Director of Quality to find out what we had done. She told me that we had agreed to put it into the CQUIN indicators for our acute contract last year (we trialled CQUINs a year early, but that is another story). “You’d have loved it,” she told me. “We had a seminar recently led by one of the orthopaedic surgeons who got up in front of his colleagues and said “I was a cynic, I am now a complete convert.”
Sometimes a commissioner can be useful. We have helped get a simple but effective technique implemented.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice
where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give
it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and
chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning
for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

  • Martin McShane

    The irony, of course, is that I didn’t follow a checklist before blogging this. From now on I will cross check dates. The NPSA sent out their safety alert in January 2009, not 2008. Looking through my diary my conversation was last year not two years ago. Darn it Gawande, your right!

  • Pawan Randev

    QoF for UK GPs contains a lot of checklists for chronic diseases.They do seem to work and by placing a clear financial incentive to practitioners have changed wholesale the management of diabetes and other LTCs. Gawande does not seem aware of this but then the book is about surgical lists. This is the missing link for commissioners – a mechanism for encouraging the implementation and auditable use of lists.

  • Yes, isn’t it wonderful. Commissioners seduced into enforcing something because its so easily measurable (and actually hasn’t been shown to be a damn bit of good outside of the 3rd World, although that’s where we’re heading in the UK)whilst we ignore how well a surgeon can consult, operate, follow-up (yes, we’re even stopping that by enforcing new to follow-up ratios)and keep up to date. We might have known it’d be ‘to hell with quality’ when we started enforcing the European Working Time Directive and stopping surgical trainees getting the experience they so desperately need. So yes, lets get them all to recite the WHO checklist. That’ll make them perfect!