When a Boston surgeon, author, and public health expert came out in late 2009 with the seminal book, “The Checklist Manifesto: How to Get Things Right,” the timing could not have been better for the food industry. The book became popular, especially among industry executives, during 2010, the year when Congress adopted the Food Safety Modernization Act (FSMA). With FSMA’s goal of preventing foodborne illnesses, every food industry executive was already thinking about the added complexity and cost. But here was Dr. Atul Gawande, who practices surgery at Boston’s prestigious Brigham and Women’s Hospital and is also a professor at Harvard University’s School of Public Health, saying something as simple as a checklist could be the key to preventing even experienced surgeons from sewing up patients with medical instruments left inside. Gawande’s clarion call for checklists was heard by government and industry. The U.S. Food and Drug Administration (FDA) now seems to be popping them out with regularity as FSMA implementation rolls along. FSMA’s Food Defense, HACCP Validation, Product Tracing and Electric Document Conformance are among the recent FDA checklists for helping companies met FDA compliance.. In many ways, checklists are turning out to be the “head of the spear” for the software and technology necessary in the war against food poisoning. If you’ve strolled through the produce section of a major grocery story lately, computerized voices are even telling people there when to do certain tasks. On the record, everybody is positive about change. Throughout the rule-making and industry comments on FSMA, complaints were numerous and public about the complexity. Something called the “water metrics” was an ongoing subject of complaint for the complexity it brought to water use for produce, and that was but one example. There have been many others. Off the record, it’s easy to get into a discussion about whether checklists, maintained by hand or computerized, are driving complexity or solving it. History does provide an answer to that question. Checklists were invented out of necessity by a committee because the government was about to make a disastrous decision to shun technology due to an unwillingness to take responsibility for making a correct, but easily misunderstood, decision. We need to “turn back time” to 1934 when Boeing, Douglas, and Martin were competing at Wright Field in Dayton, OH, for a contract with the U.S. Army Air Corps (USAAC) to provide the government with a new long-range medium bomber. Boeing’s entry to the contest was its Model 299, which “flew circles” around Martin’s Model 146 and the Douglas DB-1. The Boeing bomber model scored highest in all the evaluation categories. Then came the actual flight trials. Model 299 taxied out and took off for a smooth climb, but then stalled, turned on one wing, and fell to the ground in a ball of flames. Army Major Ployer P. Hill, who was at the controls, and Boeing’s chief test pilot Leslie Tower were both killed. The media then, like the media now, made “an instant decision” that Model 299 was “too much plane for one man to fly,” and that the contracts from the U.S. and Canadian governments should go to Douglas, the runner-up with more bomber and passenger airliner history at the time than Boeing. Several of the flying USAAC officers, however, worked behind the scenes to carve out a 12-plane order for Boeing’s model “for further testing.” But to rescue it was one thing. To save it was another. The inquiry into the accident that killed Hill and Tower, both among the world’s flying elite at the time, was “pilot error.” The elevator lock was not released prior to takeoff and, although Tower realized it soon after that, his realization came too late. Working on the problem, the air officers of the 2nd Bombardment Group at Langley, VA, figured out there was just a lot to remember when flying the complex bomber. In other words, it was not a piloting problem; it was a memory problem. Tasks had to be completed in the proper order and at the right times or accidents could happen and people could be killed. The solution the committee of pilots arrived at was the checklist. The 2nd Bomb Group then logged 1.8 million miles in the new Boeing bomber without an accident. That’s why pilots use checklists today. The Army Air Corps ended up buying 13,000 of the new bombers from Boeing. It was the most storied aircraft of World War II — the B-17 Flying Fortress. In his book, Gawande makes a comment that certainly could apply to food safety in the 21st century: “We have accumulated stupendous know-how,” he says. “Nonetheless, that know-how is often unmanageable.” Only mistakes explain why allergens have come to dominate the number of food recalls the industry has experienced over the past few years, says a food business insider. Allergen-related recalls usually follow the placement of a label which does not list an allergen known to the company and for which proper labeling usually exists. Product goes out with the wrong label just because a mistake was made. If food safety is really going to improve, government and industry agree it requires making far fewer mistakes, and that means using paper or electronic checklists, probably lots of them.
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