Monday, April 25, 2011

Check, check, oops

Six months ago I read Atul Gawande's Checklist Manifesto which extols the usefulness of standardized procedures for routine but complex tasks.  He first illustrates this idea with the example of checklists in the operating room, which have been shown to drastically increase effectiveness and reduce complications.  These surgery checklists include simple verifications like making sure everyone in the room knows each others' names, antibiotics were administered, and double checking that the procedure to be performed.  While these steps are obvious, they are also easy to forget; by following a checklist these routine mistakes are practically eliminated.

In the rest of the book Gawande considers other checklists and their context.  Probably the most famous checklists are airline pilots'.  Prior to the implementation of these checklists, airplane crashes were not uncommon; now flying is the safest way to travel.  Another example is how venture capitalists create checklists when deciding to invest in companies, including things like how leveraged the company is, or reading the footnotes in cashflow statements.  Once the VCs find a red flag, they quit analyzing and move onto the next company.  By using these checklists, they can simultaneously filter companies quicker, and increase their success rate.

As I read the book, I became excited about applying these ideas to science. Science is littered with checklists.  On the simplest level, we use recipes to make solutions. Slightly more complex are the protocols for mini-preps, PCR, and dissections (a terminal form of surgery) which  work fairly reliably.  And beyond that there are the checklists for performing actual experiments or project management.

Starting in a new lab has provided the perfect opportunity to apply these ideas, as I learn all the lab's techniques. Or in other words, I follow and write protocols. Seizing this opportunity, I started a Google docs file, and have written protocols for head-posting animals, viral injections, and multi-electrode recording.

Besides eulogizing checklists, Gawande characterizes effective checklists.  He distinguishes between DO-CHECK lists in which you perform a set of tasks, and then confirm they are all finished; and READ-DO checklists in which you read each step out as you do them (i.e. a protocol).  The checklists I have written mix these two types freely.  I usually start with a "Gather" section, including things getting ACSF or bleach, which if available will smooth out the procedure.  Then each subsequent section is a READ-DO list of what the procedure entails, with occasional stop points to make sure everything is ready for the next step.

Probably the most important part of creating and implementing checklists is that you continually improve them, and by doing so improve your procedure.  I've used my new protocols a few times since inception, and I always keep a pen handy to  write notes, including things I forgot, item locations, or clarifying language.  Probably the hardest parts of these lists are descriptive elements like, "Put a ring of cement around the olfactory bulb," which basically requires a picture of an mouse skull (I just checked, and this is possible in Google Docs, so I should probably start doing this).

This idea of constant revision speaks to the greater truth of becoming skilled at anything: the most important part of improving is that you put attentive effort into improving the process, and thereby improving results.

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