Checklists have the power to save lives

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Intensive Care Unit

The power of frequently used simple checklists in the workplace may have started with airline pilots, but it is quickly being adopted in other industries. Checklists, used frequently and rigorously, save hundreds of thousands of lives a year. The Checklist, an article by Dr. Atul Gawande in the New Yorker, is perhaps one of the most mind-blowing examples of the power of checklists. In the article, Gawande outlines the essential nature of checklists in hospital intensive care units (I.C.U.) where a million things need to be done on time and in the right order by innumerable specialists. While many of our workplaces are less complex or involve less life or death situations, we can still learn much from the success of checklists in the ICU. Some highlighted statistics:

“Pronovost [the guy who put the checklists in place] recruited some more colleagues, and they made some more checklists. One aimed to insure that nurses observe patients for pain at least once every four hours and provide timely pain medication. This reduced the likelihood of a patient’s experiencing untreated pain from forty-one per cent to three per cent.”

“In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine. Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.”

This article has now been extended into a book, “The Checklist Manifesto” – which is a great read. For fun, we actually converted a number of medical checklists to work on iPad and iPhone – Adult Cardiac Surgery Checklist, Congenital Heart Surgery, General Thoracic Surgery, though I do not know how many nurses and doctors are toting around iPads and iPhones.

For the mortals amongst us, regular and frequent use of checklists can still save lives. The importance, as demonstrated by doctors and pilots, is using checklists every single time you perform a task. We have checklists such as Forklift Daily Shift Checklist, Guide for Daily Inspection of Trenches and Excavations, Crane Operator Daily Inspection Checklist from Army Core of Engineers, Daily Vehicle Inspection Checklist and we are adding more every day.

There is no question frequent use of simple checklists makes a big difference. As demonstrated with the highly educated doctors, a large part of implementing checklists in a workplace is overcoming egos, people saying, “I know how to do my job and I don’t need a checklist!”. However, humans are not walking databases of knowledge. Humans are trained and built to react based on new knowledge, communicate and work together – let’s leave the rote memorization to the checklist or iPad.