Sophisticated areas of focus like medicine, software development, numerous sorts of manufacturing, and others abound with complicated pipeline steps. Teams and departments interact to either complement or proceed with the production process in stages that require proper coordination. At first glance, the checklist's role is not remarkable. However, a deeper analysis shows that this tool stores trivial and easy-to-forget tasks outside your brimming-with-tons-of-data brain.
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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.
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
B-17 Bombers. You’re likely familiar with the iconic B-17 “Flying Fortress” Bomber. But did you know if it weren’t for a simple checklist, it never would have gained its renown in WWII? In the 1930s, the U.S. Army Air Corps held a competition for airplane manufacturers vying to secure a contract to build the military’s next long-range bomber. Boeing produced a plane that could carry five times as many bombs as the army requested, and flew faster and further than previous bombers. On the day Boeing demonstrated its Flying Fortress, the plane lifted off the tarmac, stalled at 300 feet, and then crashed in a fiery explosion.
Gawande in 2009 introduced a hospital surgery checklist for doctors and nurses as part of a program developed with the World Health Organization. The checklist was designed to ensure basic checks were always completed before surgery. Run through the list, and you'll make sure everyone in on the same page about the surgery to be conducted, aware of who else was on the surgical team, and knows their role in the procedure.
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