Introduction of a new tool without full consideration of its purpose, benefits and limitations may actually increase risk to patients, providers and the system as a whole. Overimplementation of checklists may erode respect for long-standing healthcare cognitive aids that are effective, have been iteratively improved, and are well suited to specific purposes. Overreliance on checklists as a safety net can lead to omission of other safety practices that may better support safety through reliability and resilience. Checklists are excellent ‘aides memoire’ and directives to correct procedures, but they are not a panacea.
Now when you go to the hospital, you can have several teams taking care of you. Nurses, nurse technicians, radiologists, dieticians, oncologists, cardiologists, and so on and so forth. All these people have the know-how to deliver top-notch healthcare, and yet studies show that failures are common, most often due to plain old ineptitude. For example, 30% of patients who suffer a stroke receive incomplete or inappropriate care from their doctors, as do 45% of patients with asthma, and 60% of patients with pneumonia.
Because checklists provide a binary yes/no answer, they instill discipline in the person that uses it. Research shows that giving someone a checklist for a task increases his or her chances of completing it. There’s something about having a checklist that spurs people to get stuff done. Perhaps it’s the dopamine rush that comes with checking something off, or the concreteness checklists provide, or a combination of the two.
After impressive reductions of catheter-related blood stream infections (CLABSIs) were achieved with the implementation of a checklist bundle, checklists were promoted as evidence medicine should look to this safety solution.19 However, successful reduction of CLABSIs was not due to the checklist alone: multiple interventions addressing ICU safety were implemented at the same time, and it remains unclear what role the checklist specifically played in infection reduction.2 For example, the CLABSI checklist relies on nurse oversight. The changes in nursing behaviour can improve physician performance of line insertion in ways that are unrelated to the checklist: through the ‘Hawthorne’ effect, because the physician knows they are being watched; through empowering nurses and levelling the power gradient between physician and nurse and improving the safety culture; or, through formation of best practice as a habit as physicians insert lines the same way each time.
In healthcare, we need to get back to the basics with checklists and reserve the tool for processes that are simple, easy to follow, standardised and (perhaps) time critical. Expanding the term to cover briefings and other tools more suited to complex and variable processes is confusing, and may require communication and advanced team skills to implement and sustain. It is appealing to embrace a single tool to improve safety, and checklists have been found to be effective in some settings.16 However, the complexity of quality and safety improvement in healthcare guarantees that solutions will never be singular, straightforward or simple to sustain.
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You can leverage checklists in various areas of life. Are you going to get married? There is a wedding checklist. Is a business trip coming up? A travel checklist will help. Other options include inspection, security, packing, invitation, moving, shopping, etc. Most things are like that, your next or current project will definitely benefit from using this sort of process management tool.
We’ve mentioned debugging as a component of the deployment process. However, a process of removing existing and potential errors in the code can be optimized with checklists describing the most important steps for both novice and experienced team members. With that in mind, you will turn the never-ending process of fixing errors into an organized and tailored activity for product optimization.
It's primarally a to-do list app, but Wunderlist can also be a great tool to create checklists. It's free, runs on just about every device, and is incredibly simple to use. You can't duplicate lists, but you can make a list and share it a Public List. Anyone—on your team or around the globe—can then add the list to their account, check off the items, then add it again whenever needed. It's a workaround, one that might keep you from needing a new app just for making checklists.
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