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
‘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.
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Checkbox Form Object - Use the checkbox form field only if you are wanting to add interactivity to your checklist. The checkbox form field, found in the Forms toolbar, can link to a cell in the spreadsheet without requiring any Visual Basic programming. The linked cell will be a boolean value TRUE or FALSE. Like the drawing objects, working with a large number of checkboxes can get messy.
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
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.
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