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.
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.
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
This week I made my first checklist for setting up one of my thesis data collections. I listed specific essential tasks and supplemented them with common errors I had either made or had encountered in the past. After making this specific checklist, I decided to see if I could make a general list that could be applied to all studies. Surprisingly, it was easier to do than I thought, although I’m sure it isn’t perfect. I was able to group many of my tasks together under one common point. What is not easy so far is trusting and not deviating from the checklist. It’s been easy to throw the checklist to the side when I get frustrated. In more stressful situations or even when things are running smoothly, I may forget that I’ve come up with a structured way to make sure I’m managing my data collection in the best way possible.
Second, the roles of the team members in completing the checklist are not clear. Who will read the checklist? Who will verify that the actions have been completed? Each clinician's role in the checklist should be formalised for the surgical setting, so that when tempo is high, steps are not missed. Third, compliance requires that boxes be ticked. This means that at least one team member will be occupied with completing the checklist and thereby not be available for other tasks. Boxes are more suited to a shopping list format, where items must be completed but order is unimportant, rather than an aviation-style checklist. Problems arising from combining a memory support tool with an audit device are discussed below.
What these stubborn surgeons fail to see is that checklists provide them more freedom to exercise their professional judgment. They don’t have to think about remembering to do the stupid simple stuff because there’s a checklist for that. Offloading the need to remember basic tasks frees up the brain to concentrate on the important stuff. For surgeons, this means they’re left with more mental RAM to focus on handling unforeseen problems that often come up when you’re slicing someone open.
Law school exams. I stumbled upon the power of checklists for managing complex problems while in law school. In a law class, a single three-hour long essay exam determines your final grade. You’re presented with one or two complex hypothetical situations and are required to identify and analyze all the legal issues in them. To excel on law school exams, knowing the law isn’t enough. You have to be adept at applying it to different legal scenarios.
We’ve mentioned debugging as a component of the deployment process. However, a process of removing existing and potential errors in the code can be optimized with checklists describing the most important steps for both novice and experienced team members. With that in mind, you will turn the never-ending process of fixing errors into an organized and tailored activity for product optimization.
If you do not want to exhaust your team members’ creativity, checklists are a must-have tool for production. Their function is simple - to check whether anything is forgotten or unfinished. And the most important thing is that you do not have to create a new checklist every time a task appears. Creative energy can be channeled to the more exacting tasks.
IM Checklist program has been created by Kevin Fahey. Kevin Fahey is a very successful internet entrepreneur. He is also a well-known business coach. He had originally created the checklists to guide his students in the course of internet marketing and to educate them with various marketing ideas and strategies. However, recently Kevin Fahey has made up his mind to introduce these checklists for internet marketing strategies to the general public for the sake of educating them to become as successful in this field as he is.
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