> There are a lot of smart people in health, if the solution was simple the problem would have been solved by now.
This is completely and utterly wrong: All stable systems past their transient stage are generally at a local optimum for their respectively relevant utility function - which is shaped by the incentive structure.
Unfortunately, the incentive structure in medicine is all about avoiding liability, then making money, and actual care is a side effect. As a result, small changes can produce dramatic change in care quality. But (almost by definition) they increase liability in the short term regardless of merits (because "that's not standard practice"), and are rarely practiced.
I've spent the last 20 years in the area of patient safety and reducing medical error -- the last 10 years in building technology to assist clinical staff in improving safety. You are correct in saying the incentives are not right, but regardless, many people are in health to help people. Reducing error is hard because the 'system' isn't designed for safety (it basically isn't designed).
Checklists are used often, but aren't the solution. There are about 100 things that have to line up to get health right, saying 'checklists _alone_ will solve it' trivialising the problem.
The challenge is how to improve patient safety while improving clinical workflows. Everyone is under a lot of pressure and adding more stuff for them to do just fails.
I agree.
> Also, thinking that a simple checklist will solve medical error reflects a very simplified view of the problems in the health care system.
Indeed, yet, a simple checklist HAS been shown to significantly improve outcomes: http://www.npr.org/templates/story/story.php?storyId=1222261... .
> There are a lot of smart people in health, if the solution was simple the problem would have been solved by now.
This is completely and utterly wrong: All stable systems past their transient stage are generally at a local optimum for their respectively relevant utility function - which is shaped by the incentive structure.
Unfortunately, the incentive structure in medicine is all about avoiding liability, then making money, and actual care is a side effect. As a result, small changes can produce dramatic change in care quality. But (almost by definition) they increase liability in the short term regardless of merits (because "that's not standard practice"), and are rarely practiced.