Checklist compliance is increasingly monitored in healthcare.5 Often, institutions conduct internal audits of checklist compliance in anticipation of regulatory inspections. Using ‘compliance with checklist’ audits as a measure of safety or quality, however, is problematic, as high checklist compliance is no guarantee that the task is well-executed,18 or that patient safety culture is high.20 In addition, some of the benefits that have been found to be associated with checklist usage, such as enhanced team building and nurses speaking up, are likely to be negated if compliance audits lead to sanctions.
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.
Healthcare safety activists have looked to checklists to solve a myriad of problems, particularly with the current iteration of checklists that have been imported from aviation. Large-scale implementations with conflicting outcomes suggest that these tools are not as simple or effective as hoped. Scholars debating the efficacy of checklist implementation in healthcare have identified important reasons for varying results: that success requires complex, cultural and organisational change efforts, not just the checklist itself2; that results may be confounded by a mix of the technical and socioadaptive elements,3 and that local contexts may either augment or undermine the implementation's outcomes.4
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.
1. Checklists verify that the necessary minimum gets done. With increasing complexity comes the temptation to skip over the stupid simple stuff and instead focus on the “sexy” parts of one’s work and life. Because the stupid simple stuff is so stupid and simple, we often fool ourselves that it’s not important in the grand scheme of things. But as we’ve seen, it’s often our most basic tasks that can spell the difference between success and disaster.
Let’s take a simple example. When you get in a car, you can’t just drive because there is a set of specific operations to be done. These include fastening your seat belt, removing the handbrake, putting a transmission gear lever into neutral position, starting the engine, checking the indicators, etc. After you have checked and accomplished all these routine tasks, you can press the accelerator pedal and drive. Every driver has this checklist in his/her memory because of its regular use. If your set of tasks is bigger or varies frequently, it’s challenging to keep it memorized all the time.
Most companies strive to arrange their best practices in the most convenient way. Checklists work well here. Providing essential information for repetitive tasks in the form of a list proves a company’s consistent approach to any level of activity. As an example, introducing specific rules and policies to new team members is quite practical when done through checklists.
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