Healthcare safety activists have looked to checklists to solve a myriad of problems, particularly with the current iteration of checklists that have been imported from aviation. Large-scale implementations with conflicting outcomes suggest that these tools are not as simple or effective as hoped. Scholars debating the efficacy of checklist implementation in healthcare have identified important reasons for varying results: that success requires complex, cultural and organisational change efforts, not just the checklist itself2; that results may be confounded by a mix of the technical and socioadaptive elements,3 and that local contexts may either augment or undermine the implementation's outcomes.4

Concerns have recently been fuelled by the disappointing results after implementation of the checklist in Michigan17 and large-scale mandated implementation in Ontario Canada.5 Interpretations of results are also complicated by reported differences between perceived and actual application of the checklist. In a recent US study, hospital documentation indicated 100% compliance with checklists, but observers found that on average only 4 of 13 checklist items were actually completed.18 Even strong advocates for checklists admit that full implementation of the WHO checklist is difficult and that improvements require more than the checklist, including strong institutional leadership, data collection, and monitoring, and training in teamwork.4 ,14
When it comes to checklist implementation, it is important to recognise that aviation checklists are integral to the normal workflow. The aircraft does not stop while the checklist is completed, and the timing of checklist completion is arranged so that it does not conflict with other essential flight activities. To that end, the checklist does not impose an additional burden or workload, but is actually perceived by aircrew as something that makes the flight easier. In contrast, the Time Out is performed before the case can begin, so essentially stands independently of the workflow. To that end, the Time Out is likely to be seen as something additional, and, unless it results in obvious time-saving downstream, will be perceived as an increase in workload. This mixture of purpose between checklist and briefing, in combination with implementation issues, may explain the range of outcomes as well as the range of enthusiastic to skeptical opinions about the mandated use of checklists in surgery.14–16

Daniel Bryant sat down with Dave Sudia, senior DevOps engineer at GoSpotCheck, to discuss the benefits of PaaS; building a platform with Kubernetes as the foundation; selecting open source components and open standards in order to facilitate the evolution of a platform; and why care should be taken to prioritize the developer experience and create self-service operation of the platform.


In healthcare, this type of operational check of equipment has evolved along with advanced medical technology. Since 1993, Anaesthesia Apparatus Checkout Recommendations have targeted the proper configuration of anaesthesia gas delivery systems.9 These recommendations are intended to be peer-reviewed, modified and updated for each specific type of manufactured anaesthesia equipment. Thus, prechecks are incorporated into manufacturing and inservicing of equipment and iteratively updated by the professionals using them. Operating room and anaesthesia workflows accommodate these prechecks.
Gawande explains that we are up against two things when performing either a high volume of simple tasks or a variety of complex tasks. The first is that human memory and attention can fail you, especially when a bigger issue arises. This could be your participant being late and your data collection program freezing, making it easy to forget that you haven’t performed a baseline test. The second thing is that we skip tasks even when we remember them because nine times out of ten that step doesn’t matter. Never check to make sure your wires are plugged in correctly?  If you’re the only one working in the lab maybe it doesn’t matter, but if multiple lab mates are cycling through the lab, this could be a bigger issue.
Clinicians have long relied on an analogous form of decision support such as lists or algorithms for differential diagnosis. When a patient presentation is unusual (non-normal but not emergent), differential diagnosis lists (whether in old-fashioned textbooks or new-fashioned handhelds) support clinical performance by serving as a cognitive aid. The practice of reviewing a complete differential helps overcome anchoring and confirmation biases and can be a forcing function to ensure that every critical, and treatable aetiology is ‘ruled out’. Unlike non-normal checklists that are built into cockpit workflow, differential lists are often not well-integrated into clinical workflow and this may undermine their use.12
Non-boldface checklists are used to provide decision support when time is not critical. In complicated situations, such as multiple system failures, the checklist appears in the form of a flow chart or decision tree, helping the pilot(s) to navigate the process. In modern aircraft, the checklist is built into the electronic cockpit system, which leads the pilots through the appropriate steps on the screen. The steps are colour-coded for urgency and ranked in priority order. As steps are completed, they disappear from the screen. Checklist items are arranged in a systems operational sequence and are consistent with the patterns of motor and eye movements of the crew.
First, the structure varies from the design of aviation checklists, in that it combines procedures with formal team discussion; these processes are not mixed in the cockpit but remain distinct because they serve different purposes. The WHO checklist consists of a checklist (Sign In), a briefing (Time Out) and a checklist with a short briefing at the end (Sign Out). Checklists are suited to verification of procedures for linear processes; whereas briefings are suited to support execution of complex processes that may require appropriate adaptation and variation. Briefings are important because surgical outcomes are complex and emergent, and optimal performance of surgical procedures may require flexibility to accommodate the unexpected, however briefings should be instituted separately from the checklist. If briefings are too closely coupled to checklist completion, teams may miss the cognitive shift required to move from linear or procedural work to complex or adaptive work.
1. Checklists verify that the necessary minimum gets done. With increasing complexity comes the temptation to skip over the stupid simple stuff and instead focus on the “sexy” parts of one’s work and life. Because the stupid simple stuff is so stupid and simple, we often fool ourselves that it’s not important in the grand scheme of things. But as we’ve seen, it’s often our most basic tasks that can spell the difference between success and disaster.
And the tragic thing is it’s often the “stupid” simple stuff that gets people killed or keeps them in the hospital for longer than they needed to be. I have an acquaintance who ended up in the hospital for two weeks because he got the wrong heart medicine. The problem was ultimately one of miscommunication — a basic thing you think would be a given, seeing as how hospitals can transplant human faces and whatnot.
First, the structure varies from the design of aviation checklists, in that it combines procedures with formal team discussion; these processes are not mixed in the cockpit but remain distinct because they serve different purposes. The WHO checklist consists of a checklist (Sign In), a briefing (Time Out) and a checklist with a short briefing at the end (Sign Out). Checklists are suited to verification of procedures for linear processes; whereas briefings are suited to support execution of complex processes that may require appropriate adaptation and variation. Briefings are important because surgical outcomes are complex and emergent, and optimal performance of surgical procedures may require flexibility to accommodate the unexpected, however briefings should be instituted separately from the checklist. If briefings are too closely coupled to checklist completion, teams may miss the cognitive shift required to move from linear or procedural work to complex or adaptive work.

We may not like to admit it, but many of us can describe a time when we’ve made a mistake during the progress of a study. These mistakes can range from mixing up wires or forgetting to turn on an amplifier to forgetting to collect an essential piece of information that either requires additional processing time or prevents you from analyzing a certain variable altogether. Increased computing power and technological advancements have also made it easier than ever to collect data. We can collect five measures simultaneously in one study and hundreds of trials in no time at all. But where does this leave us now? We must set up all of this equipment and make sure it works together, monitor it as well as our participant or specimen, and somehow sift through all the data post hoc. Even with a detailed lab notebook, its no wonder problems can arise. Even just writing this makes me feel…exposed, as if I’m the only one who struggles with this. It seems so simple, how can I not get it perfect every time? I always thought that I just had to work harder to not miss small steps, but maybe I just needed a different, yet structured, perspective on how to manage such a high volume of complex information.


Checklists don't have to be boring. Pocket Lists is a fun, personal checklist iOS that lets you organize your checklists with icons. Organize the things you need to do, then add an icon to each checklist to make it easy to identify. It can manage your daily tasks, with due dates and notifications, and can also keep track of your more detailed checklists to help with your work routines.

Reinforcement and sanctions surrounding tasks may distract performance from the intent of the checklist. In healthcare, there is often a need to adapt the procedure to the patient or the context. Recent findings show that the WHO checklist, for example, is often implemented differently within single organisations, depending on context. Clinicians may be discouraged from acting in a manner that is best for the patient if they perceive that they may be censured for not following the procedure ‘to the letter’.


That’s it for theory. In practice, you can take advantage of checklists in project management (PM) tools. This sort of software is leveraged to keep the workflow organized and provide the team with the ability to see other stuff circulating in the working environment. However, the market abounds with versatile PM solutions, which is not always a benefit to an inexperienced user. Therefore, you have two paths to choose from - either take a look at a comparison post like this one, or consider the following must-have features in your search:

Gawande explains that we are up against two things when performing either a high volume of simple tasks or a variety of complex tasks. The first is that human memory and attention can fail you, especially when a bigger issue arises. This could be your participant being late and your data collection program freezing, making it easy to forget that you haven’t performed a baseline test. The second thing is that we skip tasks even when we remember them because nine times out of ten that step doesn’t matter. Never check to make sure your wires are plugged in correctly?  If you’re the only one working in the lab maybe it doesn’t matter, but if multiple lab mates are cycling through the lab, this could be a bigger issue.


Special Unicode Characters in Data Validation Lists: ☐, ☑, ✓, ✔ - This may be my favorite approach. You can include special characters like this in a Data Validation drop-down list. This isn't quite as good as clicking once to fill in a checkbox, but it is great for the mobile Excel apps. The only hard part is remembering how to insert a check mark symbol in Excel. For more information, see my article Using Unicode Character Symbols in Excel.

This isn’t a problem unique to medicine, of course. It exists across almost every domain of life, be it business or science or even just getting things done around the house or on your car. More and more of our work requires coordinating different teams to get a task done. If you work for a big corporation, you’re likely collaborating with a whole host of people to complete a project. And just as in medicine, you’ve likely seen projects delayed or even fail not because of lack of know-how, but due to head-scratching ineptitude.
That’s it for theory. In practice, you can take advantage of checklists in project management (PM) tools. This sort of software is leveraged to keep the workflow organized and provide the team with the ability to see other stuff circulating in the working environment. However, the market abounds with versatile PM solutions, which is not always a benefit to an inexperienced user. Therefore, you have two paths to choose from - either take a look at a comparison post like this one, or consider the following must-have features in your search:
However, in this in-depth, unbiased IM Checklist review, all the features of the products have been discussed with absolute subtlety of information. Besides, you have also got an idea of the pros and cons of this product. Having read this review, you have already realized the importance of this product in the context of your internet marketing needs. It is easy to decide, therefore, that using the IM Checklist course is a necessity if you have the ambition and the willingness to become a successful internet entrepreneur and improve your marketing strategies.
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