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
Checklists let you put tasks in order so you can accomplish the most important things first. Once you have put things in writing though, you might feel pressured to complete the tasks in order. This can slow you down. Some people work better when they can jump from task to task and let their emotions guide them. A checklist might impede their emotion. However, if you truly need to finish certain tasks before moving to new ones, a checklist will keep you focused and on-track.
‘Non-boldface’ checklists form part of the normal framework of ‘job aids’, which might also include mnemonics and other rote learning tools, task visibility, context-sensitive help functions, decision support and instruction manuals. Mnemonics (such as ‘ABC’ for ‘Airway, Breathing, Circulation’ in resuscitation), for example, are sometimes used to retrieve procedural items where participants are likely to be subject to high cognitive load; however, mnemonics are more critical in situations where there is no later access to a physical checklist for confirmation.
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
One thing to remember: your checklist doesn’t have to take the form of a list. One checklist I use every day is my Daily bookmark folder. It’s a bookmark folder in my browser (I use Firefox) that contain the sites I want to visit daily. Every day, all I need to do is opening the bookmark folder and it will automatically open all the sites I want. Simply by opening it I can be sure that I won’t miss anything.
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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.
Many prominent software development companies like Railsware are active users of checklists in their activities and processes. They do not limit their lists to 7 or 10 points. Sometimes, the number of points can stretch up to a couple of pages consisting of subsections for rather complicated processes. And here are some reasons why you should consider using checklists for your needs.
Sophisticated areas of focus like medicine, software development, numerous sorts of manufacturing, and others abound with complicated pipeline steps. Teams and departments interact to either complement or proceed with the production process in stages that require proper coordination. At first glance, the checklist's role is not remarkable. However, a deeper analysis shows that this tool stores trivial and easy-to-forget tasks outside your brimming-with-tons-of-data brain.
2. Checklists free up mental RAM. People often bristle at using a checklist because it feels constraining. They want to be flexible and creative, and the checklist seems to take away their autonomy. For this reason, implementing checklists among surgeons has proven difficult, even though studies show checklists dramatically reduce the number of preventable, life-threatening errors. Surgeons feel that their work requires an intuitive judgment that’s born from years of training and experience and can’t be reduced to a simple checklist.
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