1 October 2021. Rewilding | Checklists
Rewilding the Lower Elwha River; why checklists work
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#1: Rewilding the Lower Elwha River
There’s a long story in Orion magazine by Jessica Plumb to mark the tenth anniversary of the demolition of the two dams across the Lower Elwha river in Washington State and the re-wilding of the river valley. The demolition followed ‘decades of advocacy by the Lower Elwha Klallam Tribe, environmental groups, and politicians.’ The dam had been built exactly 100 years previously.
(Image: Jessica Plumb)
This meant that the moment at which they breached the dams was a big deal. 100 years of sediment was sitting at the bottom of the reservoirs, which means that it needed to be re-seeded almost immediately to prevent invasive species settling:
An estimated 24 million cubic yards of sediment collected behind the dams, creating a challenge for ecologists who hoped to jump-start the process of plant succession. Their goal was to outrace invasive plant species in eight hundred acres laid bare by dewatering, and to set the stage for a future forest. Crews collected seeds from the Elwha Valley long before the dams came down, propagating native plants by the thousands. Volunteers transplanted more than 300,000 starts while teams prepared to scatter tons of natively sourced seed. As the final day approached, restoration ecologist Joshua Chenoweth added one last seed species to the master plan, despite limited supply: lupine, known for its nitrogen-fixing capacity.
The installation of the dams on the river had blocked the passage of salmon upstream, and one of the questions about the rewilding was whether salmon would return to the river. It turns out that they do, although it has taken the best part of the decade. And salmon have a large effect on ecosystems.
In general though, one of the surprises of the project is how quickly the ecosystem recovers:
From sandbars stretching into the Strait of Juan de Fuca, to changes in wildlife upstream, the whole watershed has responded more rapidly than expected. With salmon numbers growing steadily, scientists are tracking species associated with migrating fish. One study considered American dippers, the West’s only aquatic songbird. As salmon returned to the Elwha, these charismatic birds were found to have marine-derived nutrients in their diet, which in turn made them more likely to stay in salmon-rich territory year-round, and to double-brood in one season. The Elwha experiment is revealing the role of salmon in countless other species, terrestrial and aquatic.
For Plumb, the project is also about environmental justice.
Salmon are at the heart of the Lower Elwha Klallam Tribe’s culture and economy, and tribal members were the first to protest the degradation of the river. As water rose behind the first dam, the reservoir inundated a site sacred to the tribe, believed to be the birthplace of the Klallam people. When the reservoir drained away, tribal members rediscovered the sacred place they’d lost a century earlier. This memory is now a physical place, visited by tribal members… Tribal land encompasses the east side of the estuary, and for the first time in a century, the tribe is gaining, rather than losing land.
Jessica Plumb has directed a documentary about the river restoration, Return of the River. The trailer is here:
Atul Gawande’s book Checklists is a decade old now, but there’s a good recent review of it at the blog Less Wrong which reminds us of the problem that the checklist is designed to solve:
the knowledge base and the complexity of the work grows until no single expert can fit all the relevant pieces into their head. The attentional load grows, and getting it right 99% of the time isn’t good enough. Mistakes are made, details go unnoticed, corners are cut by rushed and overworked staff, and (in the medical field at least) people die.
In the medical context, we can quantify that 1% gap. An ICU patient needs 178 tasks a day, so getting 1% wrong means that 2 tasks a day are being done properly. Sometimes that’s fatal or injurious, usually it’s not.
What I liked about this review was that it located the idea of the checklist in this gap between complexity and practitioner knowledge.
When Gawande started thinking about this in the context of medicine he found that other industries had already solved this problem. The aviation industry, in particular, had been using checklists in the 1930s to help pilots avoid making errors. The fact that he was curious enough to find this out marks him out, since there’s a long history of doctors refusing to adopt innovations—going to back to Lister and washing your hands with soap before touching patients—even when they improved patient outcomes.
The checklist trialled at John Hopkins hospital in Baltimore in 2001 wasn’t long:
One of the first checklists introduced in hospitals, aimed at decreasing central line infections in ICU patients, was trialled at John Hopkins Hospital in Baltimore, in 2001. It had five steps. The doctor was supposed to:
wash their hands with soap
clean the patient’s skin with chlorhexidine antiseptic
put sterile drapes over the entire patient
wear a mask, hat, sterile gown, and gloves
place a sterile dressing over the insertion site once the line was in
All of these were steps that doctors were already supposed to be taking, and not even hard steps.
But context matters. Doctors will probably manage to remember to do all of these things when they are fresh. But a lot of medical work is done by tired people under conditions of stress, sometimes at times of the day or night when their body clocks are slowing them down.
And interestingly, the hospital changed the social relations around practice to help the doctors to remember:
Part of the change being introduced was a social one: nurses were responsible for documenting that the doctor had carried out each step, and had a new mandate – and backup from management and hospital administration – to chide doctors who forgot items.
Infection rates fell sharply during the trial, and thereafter. But all the same, adoption isn’t universal. Health care is still far less systematic about all of this than aviation. Introducing a checklist that makes a difference and that everyone is willing to adopt is hard work. It takes months of testing and trialling. And clearly, they work much more effectively in environments that require repeated applications of routine sets of behaviour. Such as health:
But even in the poorest hospitals, using it saves lives. And there’s a broader lesson to be learned, here. In any complex field – which encompasses quite a lot of the modern world – even very obvious, straightforward instructions to check off for routine tasks can cut down on the cognitive overhead and reduce “careless” human error, making perfect performance much more feasible.
j2t#179
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