Among Gawande’s findings: “[Checklists help] with memory recall and clearly set out the minimum necessary steps in a process. … In this one hospital, the checklist had prevented forty-three infections and eight deaths and saved two million dollars in costs. … [Checklists] provide a kind of cognitive net. They catch mental flaws inherent in all of us — flaws of memory and attention and thoroughness. … I have yet to get through a week in surgery without the checklist’s leading us to catch something we would have missed.

Our study emphasizes approaching the patient as a human being and not as an anonymous case study,” Turner told ScienceDaily…

Instead of seeing patients as duffel bags of symptoms, viewing them as full-fledged human beings helps physicians in their work and patients in their treatment. This doesn’t mean doctors and nurses should abandon checklists and protocols. But it does mean that a single-minded reliance on processes and algorithms that obscure the human being on the other side of the transaction is akin to a clinical error.

To aim for zero harm in complex systems such as hospitals is not the same as aiming to erase human error. To err is human. Error will always be with us. But we can design social systems that make everyone aware of the inevitability of error and poised to catch and correct it before it causes harm. That means understanding that Swiss cheese holes sometimes line up—despite being separated by time or distance—to create a tunnel through which complex failure flows unimpeded.

1. What Is Churn?

Churn is the mental agitation and physical stress we can experience in diverse settings. Its immediate cause, as noted, is stereotype or identity threat— the threat of being judged and treated badly based on negative feelings or stereotypes about our identities: our religion, race, age, sex, sexual orientation. This threat begins with knowledge that virtually everyone has— of the feelings toward, and stereotypes about, the major identities in our society. Then, when we’re in situations on which these feelings or stereotypes apply, this knowledge carries a threat: that we could be judged and treated in terms of those feelings and stereotypes.

3. Churn Has an Antidote

When we trust, we accept. When we distrust, we resist. We look for alternative meanings and scenarios. And if the situation is important, we do this a lot; we churn.