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.
Everything seemed fine, until the patient stopped responding and his heart rate skyrocketed. The patient's blood pressure was barely detectable. Nothing his medical team did improved it, so he was rushed to surgery. Only when he was opened up did the doctor finally realize the stab wound went much further inside the patient than he'd thought, cutting right into the aorta—the main artery from the heart. Although it seemed like a small knife wound, the patient had actually been struck by a bayonet—part of the assailant's costume.
Law school exams. I stumbled upon the power of checklists for managing complex problems while in law school. In a law class, a single three-hour long essay exam determines your final grade. You’re presented with one or two complex hypothetical situations and are required to identify and analyze all the legal issues in them. To excel on law school exams, knowing the law isn’t enough. You have to be adept at applying it to different legal scenarios.
Every construction job begins with a massive checklist of tasks that have to get done and each task has an accompanying deadline. While that to-do list plays an important role in ensuring stuff gets done, an equally valuable checklist is also used. Called a “submittal schedule,” it centers on communication. The submittal schedule details which project managers need to talk to which project managers during a specific phase and about a specific process. The submittal schedule’s purpose is to get teams that are working on different yet co-dependent projects to regularly connect so they can discuss any potential sticking points. For example, there might be an item on the checklist for carpenters and plumbers to meet up at a specific time to discuss their progress on their respective tasks. Maybe a problem has come up with the pipes that affects when the carpenters can get started on their work, but perhaps there’s something the carpenters can do to help the plumbers. The trick is to keep each other in the loop so each respective team can take care of these “known unknowns” as quickly and as effectively as they can. Once the teams talk, they check the communication task as complete, and move on with their work.
Google Sheets beat Microsoft to the punch and introduced a Checkbox as one of the Data Validation options. You can go to Insert > Checkbox to quickly create one, and you can customize it by going to Data > Data Validation. I've updated most of the Google Sheets versions of my checklists to use that feature. I hope Excel gets smart and introduces a similar feature some day.
B-17 Bombers. You’re likely familiar with the iconic B-17 “Flying Fortress” Bomber. But did you know if it weren’t for a simple checklist, it never would have gained its renown in WWII? In the 1930s, the U.S. Army Air Corps held a competition for airplane manufacturers vying to secure a contract to build the military’s next long-range bomber. Boeing produced a plane that could carry five times as many bombs as the army requested, and flew faster and further than previous bombers. On the day Boeing demonstrated its Flying Fortress, the plane lifted off the tarmac, stalled at 300 feet, and then crashed in a fiery explosion.
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.
But the military still bought a few Boeings to experiment with. Some test pilots believed the Boeing bomber was a much more effective warplane and got together to figure out how they could get pilots to fly it. Instead of requiring more training, the test pilots implemented a simple pre-flight checklist. It spelled out all the basic tasks that were needed to fly the plane successfully, like checking to see if the battery switches and radio were on before taking off. By implementing the checklist, pilots flew the Boeing bomber 1.8 million miles without a single accident. Thanks to a “stupidly” simple checklist, the Army ended up ordering thirteen thousand Boeing bombers and the B-17 soared into the annals of wartime history.
If you're a fan of writing in Markdown and using keyboard shortcuts, Checkvist is made for you. It's a web app that lets you create checklists that you can print or share with others, and even set up daily reports. If you need collaborative checklist management, or you want a checklist that integrates with your favorite services like Evernote, try Checkvist.