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Occasional Advisor
Posts: 9
Registered: ‎03-15-2010

Re: Check-lists

[ Edited ]

Non-pharmacy example, but in the interface development area here as P1S, we've been looking at checklists as supporting pieces of documentation.  Documentation is essential because it includes the complete details about a particular process.  However, people will not abide  by policies that state "always go to the documentation", particularly when it is a task that people are already familiar with.


Our checklists are intended to keep people near the documentation without requiring a full re-read every time.  We'll boil the essentials of the documentation down to the essential 4-9 steps and provide a form where someone could check it off online or print it out and check on paper.


The current thinking is that we're not going to require people to file checklists "proving" they performed all steps.  Rather, we're going to look at the results of their work.  If someone forgets an essential step and they're not using the checklist, directing them to that checklist again is an appropriate corrective measure. 


Luckily, for the most part we're not performing tasks as serious as counting that all materials brought into the surgery room are accounted for outside of the patient's body.  However, as anyone in Health IT is aware these days, the regulations surrounding proper use of PHI (such as HITECH) have upped the stakes for anyone in this industry.  We've all got to find ways to bring absolute consistency to people's behaviors related to proper management of PHI.


Trusted Contributor
Posts: 141
Registered: ‎02-19-2010

Re: Check-lists

With all the checklist chatter and the release of VeriForm, I decided to read Gawande's book.  I agree with BobJ that it is an excellent read.  His style is easy to read and he continues to keep you interested by using real world examples of the points he makes. He does a good job bringing in what other industries have done to promote safety, good communication, and teamwork.  His recommendation of using checklists does not just touch on being a memory aid, but as a way to change the healthcare culture to promote the necessary teamwork to protect the patient and provide better healthcare.


Some of the key points I took away from the book were:

  • The medical profession has increased in complexity over the years.  Clinicians are now becoming "superspecialized" in their fields to handle the complexities. The construction industry became so complex in the 20th century that comparisons of specialization can be made with the healthcare industry.  The answer for construction has been to move away from the "Master Builder" - the person who designed, engineered, and oversaw construction. The culture has accepted the decentralization of authority to let the specialists make the key decisions and take responsibility for them in their fields.  Communication is key to making this work and checklists in construction are focused on making sure key communication tasks are completed. This philosophy has shown to be effective in complex situations.
  • The medical culture (and other industries for that matter) shows skepticism toward checklists, because "we believe our jobs are too complicated to reduce to a checklist." The reality is human memory and attention is fallible, especially when it comes to the routine and mundane tasks.  "People can lull themselves into skipping steps even when they remember them."
  • The checklist can act a behavior-change delivery vehicle.  It can improve communication and help distribute power which in turn improves teamwork - a key factor towards improving patient safety.
  • A systemic approach is needed to improve patient safety. "Having great components is not enough." There is a need to look at systems and study routine failures in healthcare.
  • The airline industry has checklists for routine and emergency situations.  The key to testing and improving the checklists are flight simulators.  I know that simulations are another hot topic in healthcare currently.
  • A good checklist is: precise, practical, not lengthy (recommended limit of 5 to 9 steps - which is the limit of working memory), focused on the most critical steps, simple in its wording, and ideally fits on one page.

I highly recommend "The Checklist Manifesto" if you have any interest in patient safety and how to improve healthcare.  I'm curious to hear the thoughts from some of you on the front lines about these points.  Are Gawande's thoughts and recommendations realistic or is this too idealistic? 

Valued Contributor
Posts: 110
Registered: ‎02-21-2010

Re: Check-lists

Join these recently confirmed renowned experts at APIC 2010:



Peter J Pronovost, MD, PhD, FCCM


Named one of Time Magazine's 100 Most Influential Persons.

Dr. Pronovost is author of Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out