Checklists 2.0

Suddenly the subject is topical again: how many operations do you have to do to be ‘completed’. Or at least skilled enough to be able to do the surgery on their own. A lot of research has been done, but the answer is not there to my knowledge. You may even wonder if the answer exists: every surgeon undoubtedly has his or her own learning curve: there are undoubtedly talents among surgeons who have difficulty learning. And on the other hand, there are certainly also surgeons who, although it is true that they needed a lot of guidance and instructions at the start of their training, they learn very quickly and continuously in order to develop into gifted surgeons in a short period of time.

The question is topical for two reasons: firstly, because the LACC study has shown that exploratory surgery for cervical cancer has less good outcomes than abdominal surgery. That shocked the gynecological world because it was completely unexpected. But you only had to have performed 10 (!) surgeries to be allowed to participate in the study. And we are all convinced that after 10 operations, learning is far from complete. And now exploratory surgery for cervical cancer is in danger of being cast in a bad light because a study was done on inexperienced surgeons, while with experienced surgeons there may be no differences at all.

The other reason why the question is suddenly topical is the report of the Council for Public Health and Society: ‘Token of confidence – Different accountability for good care’. Care providers literally become sick of the administrative burden that is often imposed by others in order to check whether the care that is provided complies with the rules and standards. In the report, the RVS makes a proposal to turn it around. Healthcare providers should be honored to be accountable by showing what they do and how they do it. That is the end of the checklists imposed by others.

I am for: I love to show what I have done well. But I also have concerns because what about everything I don’t show? I will therefore show that I am successfully improving continuously. But how do I show that. Exactly: with checklists to show that the changes have really had an effect. But fortunately they are now self-imposed checklists!

To reassure you: I have already ticked off more than 10 checklists, so the learning curve is fine.