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
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That brings us to the last point about checklists - they DO NOT replace knowledge. An investor interviewed for the book said it best when describing that the checklist is “not a fail safe thing…you still need expertise and insight into the process to be able to ultimately perform each step correctly”. These checklists wouldn’t help me if I didn’t know what I was doing to begin with. Rather than being a “Step by Step to Collecting Data”, people can perform a task however they want and the checklist makes sure that in the end that task was performed correctly.
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.
6. Saving lives: Checklists can literally save lives. When the U.S. Army Air Corps introduced the B-17 bomber during WWII an experienced aviator crashed the plane during its second demonstration flight. After this tragedy the Army required that pilots use a checklist before taking off. This is the same type of checklist we see pilots use today that helps to avoid crashes.
Your job desperately needs to be structured with a checklist, but if your first checklist doesn't survive, don't despair. Just like best laid plans, checklists—at least first drafts—will often go awry in the real world. Even aviation and surgical checklists are constantly being modified to be easier to use, clearer, and more useful in real-world situations.
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.
In healthcare, this technique is used in resuscitation procedures. Healthcare workers are trained and recertified, in low and high fidelity simulators, to commence procedures such as Advanced Cardiac Life Support without referring to a checklist. When the patient is not readily revived or responding as expected, the team will refer to their checklists or algorithms to make sure the steps have been executed properly, and that they have not forgotten anything. For this reason, healthcare workers often keep a cognitive aid (a ‘checklist’ of sorts) posted on emergency carts, tucked into pockets or loaded onto mobile devices. ‘Boldface’ checklists can be effective whenever there is a critical sequence to be completed but time is short, or the situation does not enable a physical list to be immediately accessed and used.
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