Checklists seem simple, Gawande says, and are sometimes hard for us to accept as a necessity when we're in high-powered jobs that rely on our skills and knowledge. But humbling ourselves by using a checklist can improve our performance and help us achieve more consistent results. "They remind us of the minimum necessary steps and make them explicit," writes Gawande. "They not only offer the possibility of verification but also instill a kind of discipline of higher performance."
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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.
Perhaps, this benefit will be most appreciated by professionals that bear responsibility for other people’s lives as in aviation or medicine. Nevertheless, a disciplined employee is always a catch. With checklists, you have a chance to develop that attractive characteristic. A narrow scope of answers ("yes" and "no") is not a burden to complete. A regular list check instills discipline in those who use it.
Boldface items are for immediate action, when the aircraft may be lost if the items are not completed quickly and in the correct order. Correct and rapid execution of these steps is so critical and essential, that pilots must complete them from memory. Through training and repetition, the paired cognitive and motor activities required to perform the checklist are stored by the pilot as procedural memory (or ‘motor skills’).10 Despite notable exceptions (such as ‘choking’ under pressure), procedural memory retrieval is less affected by stress than declarative or episodic memory retrieval.11 For this reason, aircrew practice time critical emergency procedures regularly to aid in forming the correct ‘habits’. However, as soon as time permits, the checklist is used to confirm that the steps were executed as required.8
The crux of this problem is while the world around us is becoming more and more complex, we’re still stuck with a brain that hasn’t changed much in 100,000 years. Sure, we’ve figured out ways to off-load memory storage to books and computers so we can know more; we just haven’t figured out a good way to overcome our evolved biases, cognitive flaws, and intrinsic forgetfulness. And so, despite owning a brain brimming with ever more knowledge, we continue to make stupid mistakes.
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.
2. Focus only on the “stupid” essential stuff that’s frequently overlooked or skipped. You don’t need a checklist that lists every single step on how to complete a task. That renders a checklist useless. Instead, just focus on putting down the “stupid” but essential stuff that you frequently miss. Your checklist should have no more than 9 items on it. The shorter the better.
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
When ideas are translated from one industry to another, the assumptions underlying the original concepts may be lost or diluted. As checklists are increasingly imposed through a variety of professional and regulatory mandates in North America,5 Europe6 and elsewhere,7 perhaps it is time to review the fundamental principles of checklist use, including why they might work and how we can implement them better.
We may not like to admit it, but many of us can describe a time when we’ve made a mistake during the progress of a study. These mistakes can range from mixing up wires or forgetting to turn on an amplifier to forgetting to collect an essential piece of information that either requires additional processing time or prevents you from analyzing a certain variable altogether. Increased computing power and technological advancements have also made it easier than ever to collect data.
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To-do lists are definitely awesome for getting things done, but there’s another kind of checklist as well – what I call the “routine checklist.” With a routine checklist, you write down all the steps/tasks needed to complete a certain project or process. The list of tasks never changes. You use the same checklist over and over again, every time you do that particular process/project.
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