Here's a little bit of “inside baseball” about FPM: We start preparing the content months in advance of publication. Many months. We are already thinking about the editions we'll publish in 2024. Our team works incredibly hard to put out a high-quality, peer-reviewed journal, and we have a process in place to ensure everything flows smoothly.
Not to get all “Checklist Manifesto”1 on you, but there is power in process.
This issue of FPM focuses on quality and safety. And one theme you might pick up on is reliance on standardized and automatic work-flows. When you get variability out of a process, quality and safety tend to improve. This is not “cookie cutter” medicine, and it doesn't mean there's zero room for customization.2 It's just standardization of standard things. Everyone needs a flu shot. All patients with diabetes need an A1C test. Warfarin is always a high-risk drug. Putting standardized workflows around stuff like that can improve quality and allow physicians to focus more on medical decision making.
We all do this in our lives, by the way. You probably have a standardized place where you put your keys. You always put your socks in the same drawer. Or you order the same salad at Panera every time. (OK, maybe that last one is just me.) The point is that we standardize these things to save time, reduce frustration, and avoid decision fatigue.
When I was in residency, I had a set of keys for my office, and then my home/car keys. I had my regular pager, and sometimes the on-call pager. After having left one or more of these items at home a few times (and having to grudgingly turn the car around to retrieve them), I developed my own process: “Watch, wallet, keys, keys, pager, pager, ID.” I'd say this to myself as a way to remember the things I needed to have with me every day. Although I no longer carry a pager, I use a similar mental algorithm to this day.
Next time you fly, glance into the cockpit while the door is open. You'll see the pilot and first officer going over a checklist. They know how to fly a plane; they don't need a checklist for that. It's for the incremental steps along the way. This process is known as “crew resource management,” and since its introduction in the 1970s, the number of fatal airline crashes has gone down dramatically.3
It's often said that the key to business success is to focus on “people, product, and process.” As you read this issue of FPM, look for the thread of process interwoven between articles and how it ends up being a critical part of improving both quality and safety.