The Checklist Manifesto #3

Gawande did a project for WHO, developing and putting into place in 8 hospitals around the world a 19-item surgical checklist. Over a 3-month experimental period and for all surgeries in these 8 hospitals, a member of the surgical team (not the lead surgeon) walked the team members through a series of questions or procedural steps, including checking information about patients' allergies and potential blood loss. There were basic questions that asked for verification of patient consent to the surgery and equipment checks to verify the working order of the operating room machinery. After the 3 months the experiment's results revealed a 47% decrease in deaths and an almost 50% drop in the number of infections. Serious complications as a result of surgery fell 36% after the introduction of the checklist! The operating rooms in hospitals in rich countries experienced the same results, pretty much, as those in poor countries, though admittedly the starting points were different. This is amazing and leads me to think about a checklist for teaching. Of course many such checklists exist, but how about something as simple as writing goals on the board so that students know what we want them to learn? We teachers can do that!

Checklist Manifesto #2 2/22/2011

I felt pride when I read that it was not doctors but nurses who began using checklists in hospitals, checklists for giving medications and taking vital signs and checklists for gauging pain. How amazing that instituting checklists in ICU's brought down dramatically the infection rate among patients on central lines and also reduced the occurence of pneumonia among patients on ventilators.

There's a connection to education. This speaks to the importance of written lesson plans with goals. Of course I'm a veteran who knows what I'm teaching, but like these experienced physicians and airplane pilots that Gawande writes about, I am human and I get off track and I forget what I meant to do or say. Nobody's life is at risk in my classroom, but my students' time w/ me is limited, and I mustn't waste it!

The Checklist Manifesto by Atul Gawande Blog #1

I'm asking all of the students in the best sellers class to create blogs to share their responses to their advice/ self-help books. I'll do the same about The Checklist Manifesto.

My first impression is that Gawande uses an accessible writing style. Yea! I was able to grasp what I think is the main idea of the book, as he describes it in the introductory chapter. Gawande writes of a shift in the big problem confronting the medical profession today as opposed to that of the medical profession of, say, fifty years ago. Doctors used to face the problem of ignorance; they didn't know what was wrong with their patients and didn't know what to do for them. Now, however, the problem is ineptitude; there is--and really it's amazing-- a wealth of knowledge about over 13,000 identifible diseases, syndromes and injuries. Doctors have approximately 6,000 medications and 4,000 medical and surgical procedures from which to choose in planning for their patients' treatment. The problem now is how to get it right. Doctors have to manage the complexity of what they have come to know.

Lunes (3 words/ 5 words/ 3 words)

Blue heron stands Knee-deep in the Hocking River Awaiting his lunch. Watching the joggers Along the bike path, he Turns to stare, Thinking, perhaps, that Humans chase down their meals-- Such an effort!

A Sestina Rant

Wet towels left on the bathroom floor,
Toenail clippings under the cushions of the couch,
Broken, eraser-less pencils, my size ten feet,
Loose buttons and zippers that stick
Arriving just moments after the traffic light changes red,
Arriving home after dark, fumbling to find the slot for the key.

Late of a morning, running in frantic search of the car key,
Orange juice spilt on the kitchen floor.
Paper cuts, especially those I don’t notice that bleed red
Onto the arm of the still-too-new-for-stains couch.
There’s the bedroom door that sticks
And sleepless winter nights I suffer with cold (size ten) feet.

That I, an educated woman, fail to grasp poetic meter (in feet)
That I lack the confidence to remove from my key ring a key
That opens nothing anymore. What’s wrong with me? I’m a stick
In the mud tracking footprints over the poorly-installed linoleum floor
As I cross to the family room to find the afghan rumpled up, left on the couch,
One arm cover of which, despite my cleaning diligence, holds the faintest red.

That I’m too old, my face too lined for hair the color red,
That arthritis has spread from thumbs to knees to feet
So that without kneeling I fail to reach the dust balls under the couch,
That my favorite old hymns are written in the most difficult of keys,
That despite my caution, water overflowing the plants’ pots stained the hardwood floor
And speaking of old, that envelopes matching my note cards have lost their stick.

In the sink the dirty pot to which rice sticks,
Robbing me of precious time with the newspaper I would have read
Earlier had it not been for the recycling and towels tossed on the floor.
The injustice that I, too, will develop bunions on my feet--
As if the arthritis isn’t bad enough-- is key
To the sense of defeat that leads me to the couch,

Where I remember another stain, one on the underside of the cushion on the couch,
A stain he stupidly tried to remove with a bleach stick.
That even with my reading glasses I cannot read the street names on the map key.
So it isn’t the glasses. That even when I steal a few minutes I don’t get much read
Before I fall asleep. That I buy only sensible shoes for my feet,
That one day I’ll have to consider moving the washer and dryer to the ground floor.

That the key wardrobe advice to dress in bright colors like red
Will one day fall with “No eating on the couch” and “Sandals hurt the feet”
Into the abyss of drivel that no longer sticks in my mind as I rant shuffling in my bedroom slippers across the stained hardwood floor.

Why I Write (journal entry)

I like how Joan Dideon put it when she said, "Had I been blessed with even limited access to my own mind there would have been no reason to write. I write almost entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear." That's true for me, too. Students tell me all the time, "I don't know what to write about." Neither do I. I just write. Freewriting is maybe the way I come up with the what that I'm going to write. I can't imagine how J.K. Rowling could plot out, before she wrote them, all seven Harry Potter books on napkins at a coffee shop. I also appreciate how Joan Didion admits to being "not in the least an intellectual." That's not the same as not in the least smart. I'm that way, too, and I remember images over facts, too, like what sweater I was wearing the day that Claudia Solt vomited all over me on her way to the pencil sharpener one morning in third grade. I remember the warmth of the liquid as it spread across my back. I don't remember the names of books I've read or movies I've seen. I can't remember more and more these days, but images I do remember. I write for the challenge of writing, and I find that I have more to say once I write enough to uncover them. I write to communicate, certainly, though I sometimes doubt my ability to deliver a cohesive message. I don't want to bore anyone or lose anyone, and I think that if I could write more succinctly, I'd avoid that and probably still communicate. In the interest of succinctness, then, I'll quit here.

4 haiku and a tanka

Wonder what monster ants
Go wandering through tunnels
Inside mounds of mulch?


Just a little wind
Stands between John Siemer and
his haiku poem.


No matter which way
I turn my back to the wind--
Hide and Seek I lose.


Single brown oak leaf
Lies in the grass at my feet,
The start of a pile.


The roaring of trucks
On the divided highway
Overpowers birds’
Peeping and cheeping—even
The protracted locust buzz.