Check This Out: Checklists Can Help Providers Manage Healthcare Complexities

Have you ever locked your keys in your car? Or left the car lights on all day only to be met with a dead battery when it was time to head home? I’ve done both more than once. In fact, I even locked my keys in the car while it was running. Fortunately, it was just in my driveway and there was an extra set in the house. I’ve also left my car keys on the hood of my car overnight. Luckily, I live in a quiet suburb and both the car and the keys were still there in the morning.

I’ve noticed I do these absentminded things when I’m under stress, learning something new or, for some reason, am out of my usual routine. When things are status quo, I’m like a well-oiled machine and can function on autopilot without any issues. But when I’m trying to cram new knowledge into my noggin or get some different synapses firing, the likelihood of me overlooking something simple – like turning off the car lights – increases.

If something as seemingly unimportant as car keys can be forgotten – really the worst outcome is that I have to call AAA or have my husband bring me an extra set – what types of extremely important actions or interventions are being forgotten in the highly complex world of healthcare?

This is the premise of The Checklist Manifesto: How to Get Things Right by writer and surgeon Atul Gawande.

I first heard about Gawande’s work with checklists about around 2010 during an interview on NPR. I thought it sounded like a simple solution and wondered if it really could work to decrease errors and to improve patient outcomes. I thought the piece was interesting and I guess I was on the fence about how to feel about the checklist idea. Was it a totally silly idea? No, I thought it could work in some situations. But like any change in healthcare it would require support from administration, staff buy-in and on and on. A simple idea, certainly, but sometimes it’s those simple ideas that are most difficult to implement.

But then I remembered an interview I heard on the Daily Show with Capt. Chesley Sullenberger. Better known as Sully, Sullenberger was the pilot who, with the help of his co-pilot and flight crew, safely completed an emergency landing of US Airways Flight 1549 in New York City’s Hudson River in January 2009.

There are a few things that amaze me about the interview between Jon Stewart and Sully. First, is the calm the pilot exudes. He does not seem like one to get frazzled should things – like a bunch of geese getting sucked into your plane’s engine – not go as planned. Second is his emphasis on checklists. When the engines were shut down because of the bird strike, he and his co-pilot did not panic. They went through their checklist. The checklist guided them on what to do during this type of emergency and the outcome was excellent. If a checklist could prevent a large scale disaster like a plane crash-landing in New York City, couldn’t it have an affect on healthcare?

checklist“The Checklist gets the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with, and let’s it rise above to focus on the hardstuff,” said Gawande in his book.

Gawande admits checklists are not the panacea for all that ails healthcare but rather a tool, that if used well, can make a huge impact on patient care. He uses checklists in his surgical practice and says the simple tool has prevented potential errors on more than one occasion.

After my latest car key incident, this time I lost them inside my office, later to find them in a drawer, I decided I should probably give this checklist thing a chance. Marketade has a good article with tips on how to make a good check list vs. a not so good checklist.

Here’s a few of their tips (the full article has more detail):

  1. Keep them short and simple.
  2. Use task checks for dumb but critical stuff
  3. Use communication checks for complex stuff
  4. Pick the right type of list.
  5. Test and adapt.

Because I carry enough paper already, I’m looking for a checklist that is either iPhone or Android compatible. I’ve found some reviews on Lifehacker but would love get feedback from our loyal readers. Do checklists work for you? What apps do you recommend? I’m eagerly awaiting your responses….so I can check that off my list!

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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.

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