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, 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.
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. We can collect five measures simultaneously in one study and hundreds of trials in no time at all. But where does this leave us now? We must set up all of this equipment and make sure it works together, monitor it as well as our participant or specimen, and somehow sift through all the data post hoc. Even with a detailed lab notebook, its no wonder problems can arise. Even just writing this makes me feel…exposed, as if I’m the only one who struggles with this. It seems so simple, how can I not get it perfect every time? I always thought that I just had to work harder to not miss small steps, but maybe I just needed a different, yet structured, perspective on how to manage such a high volume of complex information.
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.

Aviation checklists are designed for modern aircraft that are complicated, not complex; it is usually possible to define a single process path that offers optimum performance for each flight condition. These process paths are flight tested, endorsed (with minor modifications) by airlines when they purchase a new aircraft type, and published in procedural manuals and checklists. There are two categories of checklist used in the cockpit: normal and non-normal (or emergency) procedures.


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.
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.

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