Boldface items are for immediate action, when the aircraft may be lost if the items are not completed quickly and in the correct order. Correct and rapid execution of these steps is so critical and essential, that pilots must complete them from memory. Through training and repetition, the paired cognitive and motor activities required to perform the checklist are stored by the pilot as procedural memory (or ‘motor skills’).10 Despite notable exceptions (such as ‘choking’ under pressure), procedural memory retrieval is less affected by stress than declarative or episodic memory retrieval.11 For this reason, aircrew practice time critical emergency procedures regularly to aid in forming the correct ‘habits’. However, as soon as time permits, the checklist is used to confirm that the steps were executed as required.8
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.
Most companies strive to arrange their best practices in the most convenient way. Checklists work well here. Providing essential information for repetitive tasks in the form of a list proves a company’s consistent approach to any level of activity. As an example, introducing specific rules and policies to new team members is quite practical when done through checklists.
In healthcare, this technique is used in resuscitation procedures. Healthcare workers are trained and recertified, in low and high fidelity simulators, to commence procedures such as Advanced Cardiac Life Support without referring to a checklist. When the patient is not readily revived or responding as expected, the team will refer to their checklists or algorithms to make sure the steps have been executed properly, and that they have not forgotten anything. For this reason, healthcare workers often keep a cognitive aid (a ‘checklist’ of sorts) posted on emergency carts, tucked into pockets or loaded onto mobile devices. ‘Boldface’ checklists can be effective whenever there is a critical sequence to be completed but time is short, or the situation does not enable a physical list to be immediately accessed and used.
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 explains that we are up against two things when performing either a high volume of simple tasks or a variety of complex tasks. The first is that human memory and attention can fail you, especially when a bigger issue arises. This could be your participant being late and your data collection program freezing, making it easy to forget that you haven’t performed a baseline test. The second thing is that we skip tasks even when we remember them because nine times out of ten that step doesn’t matter. Never check to make sure your wires are plugged in correctly? If you’re the only one working in the lab maybe it doesn’t matter, but if multiple lab mates are cycling through the lab, this could be a bigger issue.
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.
Pre-flight checklists are a good example. A regular pilot is aware of the importance of checking a list of tasks to prepare an airplane for takeoff. These include checking the operation of the altimeter, fuel gauges, flight controls, magnetos, engine idle, and other system parameters. Besides, preflight checklists are usually segmented in a way that the accomplishment of final items (status of doors/windows, mixture, lights, camera, and action) is completed after the set of initial tasks. The same thing is with the before-landing checklist. According to the FAA's practical test standards, these sets of tasks must be in a written form for pilots’ use.
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.
You might have heard a lot about Internet Marketing especially if you want to start an online venture. But oftentimes, you lack the knowledge on how to start and may get confused about different platforms you want to use to begin your online marketing journey. But a successful marketer, Kevin Fahey has created the IM Checklist, designed to make your marketing easier and more profitable.
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.
‘Non-boldface’ checklists form part of the normal framework of ‘job aids’, which might also include mnemonics and other rote learning tools, task visibility, context-sensitive help functions, decision support and instruction manuals. Mnemonics (such as ‘ABC’ for ‘Airway, Breathing, Circulation’ in resuscitation), for example, are sometimes used to retrieve procedural items where participants are likely to be subject to high cognitive load; however, mnemonics are more critical in situations where there is no later access to a physical checklist for confirmation.
Our checklists and checklist templates are licensed for personal use only. However, to avoid a bunch of emails, I will also say that I am okay with you doing almost anything with these checklists except posting the checklist (or anything you have created using the checklist template) on the internet or selling it. That includes permission to print and distribute as many paper copies of your checklist as you need. Don't remove the copyright or hyperlinks that I've included in the spreadsheet, though.
NO, I don’t. I call them “to do” lists. LOL! They’re very helpful, they keep me sane and keep stress away. For many years now, I keep a daily list prepped the night before; and a weekly list that’s prepped every Sunday. Keeps things smooth-sailing all the time. So at the end of the day, if all items are crashed-out (as in “done”!), I feel so good about myself. :)