In healthcare, this type of operational check of equipment has evolved along with advanced medical technology. Since 1993, Anaesthesia Apparatus Checkout Recommendations have targeted the proper configuration of anaesthesia gas delivery systems.9 These recommendations are intended to be peer-reviewed, modified and updated for each specific type of manufactured anaesthesia equipment. Thus, prechecks are incorporated into manufacturing and inservicing of equipment and iteratively updated by the professionals using them. Operating room and anaesthesia workflows accommodate these prechecks.
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.
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.
Every construction job begins with a massive checklist of tasks that have to get done and each task has an accompanying deadline. While that to-do list plays an important role in ensuring stuff gets done, an equally valuable checklist is also used. Called a “submittal schedule,” it centers on communication. The submittal schedule details which project managers need to talk to which project managers during a specific phase and about a specific process. The submittal schedule’s purpose is to get teams that are working on different yet co-dependent projects to regularly connect so they can discuss any potential sticking points. For example, there might be an item on the checklist for carpenters and plumbers to meet up at a specific time to discuss their progress on their respective tasks. Maybe a problem has come up with the pipes that affects when the carpenters can get started on their work, but perhaps there’s something the carpenters can do to help the plumbers. The trick is to keep each other in the loop so each respective team can take care of these “known unknowns” as quickly and as effectively as they can. Once the teams talk, they check the communication task as complete, and move on with their work.
Whenever he went on business trips, my Dad would always write down the items he would need to take. His checklist would include articles of clothing, types of clothing to take, and personal hygiene items, along with the work-related items he would need. Although I cannot be certain, I strongly suspect he also included lists of work-related issues that he either knew about ahead of time or at the very least he would make a note of to bring up during the trip. That way, he would ensure that nothing would be forgotten by him or left to chance.
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.
As you can see, the power of checklists is not an illusory phenomenon. A famous surgeon, Atul Gawande, even wrote a book dedicated to this topic. Despite their simplicity, checklists give an extraordinary boost to organizing things in the most effective manner. Though, maybe their very simplicity underlies their power? Anyhow, you should try a few out. That is the only way to realize why you need checklists.
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