“Knowledge has both saved us and burdened us. That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our human inadequacies. And there is such a strategy – though it will seem almost ridiculous in its simplicity… It is a checklist.” ~ Atul Gawande
The Failure Option
There is no question that the world has become increasingly complex. There is more to remember, more tasks to complete, and more expected of everyone working in most every profession. We have become smarter, with more skills and technology that help us do amazing things. Unfortunately, even with all the knowledge available, the news is filled with accidents that occur as a result of memory or task failure. Ships run aground, doctors cut off the wrong leg, airplanes crash, and brakes fail to work because someone somewhere forgot to do something important. Whether the memory loss is due to having too many things to remember, or things being so mundane that they are overlooked, every business can benefit through the use of checklists.
Why Checklists Work
“In a nutshell, checklists ensure people are applying all the knowledge and expertise they have consistently well,” says Atul Gawande.
The aviation industry is credited with starting the checklist process in an effort to make sure pilots did everything needed to properly fly the “new and advanced” Boeing 299, which was more advanced than any airplane to date. However, checklists are now used to carry out complex tasks required by firefighters, insurance companies, police departments, hospitals, and more.
Whether used in routine and repetitive situations, or last-minute emergencies, checklists help people prioritize what is important, and balance judgment and procedures. Checklists can also be used when coordinating activities involving diverse teams that are working together such as those involved in construction projects, car manufacturing, and patient care. Using checklists, every stage of the process can be standardized so that each group involved completes the appropriate steps as needed and on schedule.
Checklists in Medicine
In 2001, John Hopkins Hospital started using a simple checklist of steps to help decrease the incidence of central line infections in intensive care. The simple steps were:
- Wash hands with soap before treating the patient
- Clean the patient’s skin with chlorohexidine antiseptic
- Put sterile drapes over the entire patient
- Wear a surgical mask, hat, sterile gown and gloves while carrying out the line insertion
- Put a sterile dressing over the insertion site once the line is in
After a year of monitoring the results, they found that the ten-day infection rate went from 11% to zero. This prevented forty-three infections, eight deaths, and saved $2 million in costs over a fifteen-month period.
Over the past few years, the benefits of checklists in medicine have reduced numerous medical complications, saved countless lives, and conserved billions of dollars. From local health departments to the World Health Organization, checklists are not only helpful, but are critical to successful patient care programs.
Patient Care Checklists
Healthcare professionals are required to complete a variety of complicated tasks for every patient they work with. After time, these tasks can become repetitive and mundane, even boring. It’s not uncommon for nurses to do the same procedures so often that they are “on automatic” and do them without much thought. However, these types of tasks are where a checklist can be most helpful. In nurse triage, following a checklist ensures that nothing is overlooked or forgotten. It helps keep health professionals focused even on the most repetitive, commonplace tasks. AND, checklists put every step in order, making sure corners are not cut, and procedures are standardized. This standardization is highly beneficial when evaluating patients as it provides consistent responses to specific symptoms, conditions, and circumstances.
From the first phone call or visit, to the patient’s hospital discharge or follow-up care routine, a checklist can help nurses, physicians, and all other professionals make better decisions in a more time-efficient, uniform and quality-focused manner. To make things even easier, today’s technology offers automated checklists that help streamline each process while putting less stress on the user. The combination of technology and checklists can be an invaluable combination, especially in medicine.
What tasks do you engage in that could benefit from a checklist?
What checklists do you use that you couldn’t live without?
We would like to know—type in your replies in the comments box below.
This article is a summary of The Checklist Manifest: How to Get Things Right” written by Atul Gawande. It is available at www.thechecklistmanifesto.com