5 Ways to Build a Successful Checklist
Checklists save lives. Let me say that one more time for the people in the back. Checklists save lives. You don’t have to believe or trust me on this…in fact, when I say this, people usually respond with a distrusting facial expression. So, instead of convincing you purely on my own, check (pun intended) these out:
· Checklists in hospitals have decreased preventable care-related disease (Pageler et al., 2014)
· Aviation checklists have decreased equipment failures and human error (Grestle, 2018)
There is of course, much more data on the topic but making checklists a part of the procedure, increases outcomes and adherence to necessary tasks. For example, according to Pageler et al., (2014) a decrease in bloodstream infections to pediatric ICU patients came from an enhanced checklist that was displayed to healthcare professionals when a dressing change, port needle, or other task was necessary. A dashboard with compliance information was also viewable by all healthcare professionals on the system. The rates of bloodstream infections decreased from 2.6 per 1000 line in days to .7 per 1000 line in days. There was an increase in prevention best practices, across the board. I don’t know about you, but I would prefer my loved one go to the hospital with the checklist!
In the past 20 years, “the rate of fatal accidents per million flights fell by a factor of five” (Grestle, 2018, p. 3). Aviation took on checklists after they realized important things could not be left to memory. Major (and minor) errors were mostly eliminated with the use of checklists; lives have been saved! I could go on forever about the problem with relying solely on human memory, but I will save you and focus on the beauty of checklists. (Aviation also used resource management changes and system changes to increase safety and protocols.)
Let’s talk about the 5 actionable steps you can begin using to implement a successful checklist.
1. Identify
This is the easy part. You are going to identify something that gets missed. This can be something you forget to do, a process your team doesn’t follow, steps that everyone should follow to promote a consistent and clear message to consumers, etc. It may be on thing or five things. Write them down and make sure they are the only things that need to be identified.
2. Create
This is the part that takes work. You must put it together from step one to completion…speaking of hard work, are you ready for lunch?
Do you remember that exercise your teacher had you do in the first grade? They brought out a loaf of bread, peanut butter, jelly, and a knife. They had someone in class instruct them on how to make a PB&J. They followed the student’s steps to a T. This usually ended up with some disaster item that was not a PB&J sandwich because the instructions weren’t explicilty clear! Stay away from amiguity or unclear language.
You are going to want to balance your checklist. It can’t miss important steps/expectations but you must avoid creating a procedure manual…because there are procedure manuals for that. Your checklist is for someone who is qualified and trained for the position but may need some clarifications.
A way to construct the checklist is to do the following:
write down the steps in chronological order according to the workflow/process
highlight resources or additional materials that may be needed from other areas or processes
request someone who would use the checklist on a regular basis to review your outline
write in plain and simple language, avoiding unecessary jargon, slang, or acronyms
3. Fix it
You are going to try it out/give it to your team. Have a small pilot group use the checklist for a specified amount of time. Ask the users to make feedback notes on the back of the checklist and submit them to you.
You will need to fix the checklist.
There is probably another checklist item that can added or deleted. There may be an area to add for staff to sign off, if it requires multiple users. You may be able to have it as paper or as a digital form to be submitted. Either way feedback is good, even if you got it right the first time!
“Tweaking” the to do list and having the same people or an additional person try out the checklist is important before implementing it across the entire department. You will want to spend some time in this area! Make sure there is enough time for problems and issues to come up within the workflow or process so the checklist can reflect any necessary troubleshooting actions.
4. Procedure
Make it a part of procedure, not just a suggestion.
You must make the expectations clear. For checklists to work, they must be used. If you change the procedure to include a section about completing a checklist and provide training, learning time, and reinforcement, you should have success. Provide these expectations in many ways. This could mean:
- an introductory email
-text
-newsletter
-in-person training
-pre-recorded 2 minute video
Use the right language. You do not want to say anything about the checklist that makes it seem like it is not a requirement to be completed. Statements like, “It would be really nice if everyone used it” is a failed attempt at setting an expectation.
5. Analyze
You must collect data…this can be qualitative or quantitative. Find out how the checklist is working! Track how often it is forgotten (maybe it needs to be in a highly visible place). Analyze whether the checklist has worked in decreasing or improving whatever you identified! Then, let everyone know about it…and be honest. If it hasn’t been working but people have been filling them out, maybe they don’t have the technical skills for their job and a checklist is like putting a band aid over a broken bone. Maybe the core issue wasn’t identified, which means starting back at #1!
With that, good luck on your checklists!
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Resources:
Gerstle, C. (2018). Parallels in Safety Between Aviation and Healthcare. Journal of Pediatric Surgery. doi:10.1016/j.jpedsurg.2018.02.002
Pageler, N. M., Longhurst, C. A., Wood, M., Cornfield, D. N., Suermondt, J., Sharek, P. J., & Franzon, D. (2014). Use of Electronic Medical Record-Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs. Pediatrics,133(3). doi:10.1542/peds.2013-2249