One thing to remember: your checklist doesn’t have to take the form of a list. One checklist I use every day is my Daily bookmark folder. It’s a bookmark folder in my browser (I use Firefox) that contain the sites I want to visit daily. Every day, all I need to do is opening the bookmark folder and it will automatically open all the sites I want. Simply by opening it I can be sure that I won’t miss anything.
Reinforcement and sanctions surrounding tasks may distract performance from the intent of the checklist. In healthcare, there is often a need to adapt the procedure to the patient or the context. Recent findings show that the WHO checklist, for example, is often implemented differently within single organisations, depending on context. Clinicians may be discouraged from acting in a manner that is best for the patient if they perceive that they may be censured for not following the procedure ‘to the letter’.
If your business needs checklists for various tasks or departments, Tallyfy might be the best solution. It lets you create master checklists that act as templates. You can then create a "run," or an instance of that master checklist, with its own name. Each run can be tracked, so you can see how your checklists are progressing, and you can have multiple runs of the same master checklist going at once. You can also invite your team to work on a checklist run, making it simple to manage team processes.
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.
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.
That brings us to the last point about checklists - they DO NOT replace knowledge. An investor interviewed for the book said it best when describing that the checklist is “not a fail safe thing…you still need expertise and insight into the process to be able to ultimately perform each step correctly”. These checklists wouldn’t help me if I didn’t know what I was doing to begin with. Rather than being a “Step by Step to Collecting Data”, people can perform a task however they want and the checklist makes sure that in the end that task was performed correctly.
First, the structure varies from the design of aviation checklists, in that it combines procedures with formal team discussion; these processes are not mixed in the cockpit but remain distinct because they serve different purposes. The WHO checklist consists of a checklist (Sign In), a briefing (Time Out) and a checklist with a short briefing at the end (Sign Out). Checklists are suited to verification of procedures for linear processes; whereas briefings are suited to support execution of complex processes that may require appropriate adaptation and variation. Briefings are important because surgical outcomes are complex and emergent, and optimal performance of surgical procedures may require flexibility to accommodate the unexpected, however briefings should be instituted separately from the checklist. If briefings are too closely coupled to checklist completion, teams may miss the cognitive shift required to move from linear or procedural work to complex or adaptive work.
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.
Clinicians have long relied on an analogous form of decision support such as lists or algorithms for differential diagnosis. When a patient presentation is unusual (non-normal but not emergent), differential diagnosis lists (whether in old-fashioned textbooks or new-fashioned handhelds) support clinical performance by serving as a cognitive aid. The practice of reviewing a complete differential helps overcome anchoring and confirmation biases and can be a forcing function to ensure that every critical, and treatable aetiology is ‘ruled out’. Unlike non-normal checklists that are built into cockpit workflow, differential lists are often not well-integrated into clinical workflow and this may undermine their use.12
So let's talk about and answer the question, why are checklists important? Checklists help you get all your daily, weekly, monthly and yearly tasks completed and done on time. Checklists allow you to focus and stay on track to keep deadlines on all your projects. If you have employees they set the perfect example and gives them a point of reference to start and to finish.
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.
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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