Tuesday, April 19, 2011

Tools for consistency

Atul Gawande writes in his book The Checklist Manifesto: How to Get Things Right about using a checklists as a form of discipline for complex tasks or when working with teams to verify critical items are completed. They are used in many ways: building a sound stage for a rock concert, flying airplanes, cooking restaurant meals consistently, ensuring communication tasks on building projects, and operating rooms. He makes an excellent case for their use noting that if a medication had the same efficacy as the checklist, it would be lauded all over. However, the humble checklist lacks the glamour of a drug. His case is so persuasive, I wondered where I might add one. I also thought about some of the great saves in my nursing career from checklists. In nursing there are too many things to do and not enough time to do them. With all of the juggling, mistakes happen. There ought to be a checklist for every contingency in the hospital, just like pilots use in airplanes. It might sound cumbersome, but he uses the example of a patient in ICU needing 178 daily tasks performed correctly just to survive; there are more tasks needed depending on your illness, need for surgery, and any additional problems that evolve whether from equipment failure, staff shortages, other patient needs, and family concerns. Nurses stay abreast of a patient's state of health with vital signs, physical exams, and charts that in essence function as checklist. After reading this, there needs to be more frequent revisions and a tighter focus that gets at the critical elements while balancing their usefulness to avoid redundant paperwork.

In an attempt to keep track of our children, we replaced the alarms on their backpacks with a safety phone. In addition to sounding an alarm, it can call mama, dada, home, or for emergency services. It is easy to use. The Mule called me seven times in an hour and half to let me know where she was as she went from friend's house to friend's house. I was surprised at how much she liked this. I might need to add some minutes to the plan before the month ends. The Moose hearing me repeatedly answer the phone said, "I want to go outside so I can call you too!" He skipped out with his phone in hand. "Put it in your pocket!" I called after him. My hope is that the phone will allow us to check in with the kids more easily and that the novelty will wear off soon.

The Moose was not home at the expected arrival time yesterday. I started down the walking path to trace his whereabouts. Five minutes later, I found him walking with one of the older neighbors. She only spoke Japanese, but I understood he had walked with a friend until his friend turned off the path. The obasan trailing him said, "Yukurri!" and turned back. He is a slow walker. I chuckled. You can not hurry the Moose. I showed him the phone, his face lit up. "I can call you from school?" he asked. "Yes, but only in an emergency," I said. The phone idea was prompted by the long walks that are a part of life here. "Do I have to go to school tomorrow morning?" he asked. "Yes," I said. He is beginning to notice there is less time to play.

"Brothers, I was forbidden by my Master to reveal during his life the marvels I had seen. One of those marvels was that his knowledge, which so wondrously surpassed that of other men, was not due to any human skill, but to the merits of his prayers. For whenever he would study, or dispute, or read, or write, or dictate, he would first betake himself to prayer in secret," Brother Reginald revealed after Saint Thomas Aquinas' death as written in the Introduction by Rev. Hugh Pope to Thomas' book On Prayer and the Comtemplative Life.

My days seems to spiral out of control upon rising. I have been thinking that I need some kind of change. Starting my day by thinking of my intentions and motivations, instead of all of the tasks is a shift I have yet to master. Even taking a minute to mumble to myself as I wash my face or take a shower sets the tone for keeping my heart on things beyond myself- toward kindness, toward creation, toward giving and forgiveness. Then those daily tasks of preparing meals, cleaning, teaching my children English, and my to do list, are underpinned with an elemental purpose. For me, whether the format is a checklist to keep us focused on critical steps, or a ritual to keep us grounded in times of chaos, or a prayer to lift our intentions above base needs, it seems this kind of discipline is essential for consistency and ultimately happiness.

I will leave you with a blessing from John O'Donohue's book To Bless the Space Between Us: A Book of Blessings.

A Morning Offering by John O'Donohue
I bless the night that nourished my heart
To set the ghosts of longing free
Into the flow and figure of dream
That went to harvest from the dark
Bread for the hunger no one sees.

All that is eternal in me
Welcomes the wonder of this day,
The field of brightness it creates
Offering time for each thing
To arise and illuminate.

I place on the altar of dawn:
The quiet loyalty of breath,
The tent of thought where I shelter,
Waves of desire I am shore to
And all beauty drawn to the eye.

May my mind come alive today
To the invisible geography
That invites me to new frontiers,
To break the dead shell of yesterdays,
To risk being disturbed and changed.

May I have the courage today
To live the life that I would love,
To postpone my dream no longer
But do at last what I came here for
And waste my heart on fear no more.