| In his recent book The Checklist Manifesto, Dr. Atul | | | | do, however, have a problem with being told what to |
| Gawande describes in great detail the creation of the | | | | do. Here is a recommendation: be pro-active. By being |
| World Health Organization's Safe Surgery Checklist. | | | | against something you are on the losing side of the |
| Checklists for healthcare were first discussed by | | | | issue. The next time something does not go as |
| Gawande in an article in the December 2007 issue of | | | | planned, you might be slapped with another checklist |
| The New Yorker titled (what else?) The Checklist. The | | | | developed by some external expert that may have no |
| central point of this article is how the use of a 5-point | | | | knowledge of your processes and culture. Cross the |
| checklist helped in dramatically reducing infection rates | | | | road to the sunny side and embrace the Culture of |
| associated with the insertion of central lines. There you | | | | Continuous Improvement that Lean brings to the OR. |
| have it, one shining example of the power of the | | | | Next time you see a process that has some |
| humble checklist. Why then are healthcare | | | | weaknesses and potential failure points, organize an |
| professionals so slow are at adopting standardization | | | | OR team for a Kaizen project. Outsiders and |
| practices in their daily work? | | | | consultants are welcome, but this is your project, not |
| Standard Work is not your enemy! There is a | | | | somebody else's. Plan for a maximum of three days |
| misconception among clinicians that by standardizing | | | | to complete the project and deliver a functional |
| some of the repetitive tasks they do every day, they | | | | checklist. Evaluate the process and figure out the |
| will lose the autonomy that characterizes their | | | | critical works elements that may lead to failure. Test |
| professions. Nothing could be farther from the truth. By | | | | the checklist with staff. Do a quick pilot run, make |
| making repetitive work predictable, you save your | | | | tweaks, implement it, observe the new process, gather |
| energies for the unpredictable. For example, by making | | | | performance data, and prepare a quick presentation to |
| sure that there is a clear and repeatable procedure to | | | | tell your success story. Here are a few pointers that |
| assemble case carts and deliver all the required | | | | may help you develop an effective checklist: |
| supplies to the OR prior to the surgery, you can | | | | Decide on the type of checklist. A Do-Confirm |
| dedicate all your energies to the patient, and not to | | | | checklist assumes that team members work |
| hunting for supplies or wondering if everything you | | | | independently from memory until they stop to go over |
| need is there. Do not be afraid of standard work, just | | | | the checklist to confirm that the right steps were |
| trust your judgment as to what processes should and | | | | completed. With a Read-Do checklist one team |
| should not be standardized in your clinical work. | | | | member carries out the tasks while another one reads |
| Checklists are a tool to aid with standardized work. | | | | each task and checks them off as they are |
| They aim at ensuring repeatability of certain critical | | | | completed. |
| elements of work. Wash hands with soap, check. | | | | Make it short. It is a checklist, not a training manual. |
| Clean procedure area with chlorhexadine, check. We | | | | The checklist is not there to tell you how to do the job. |
| are all humans and we are bound to forget something, | | | | Think index card, rather than legal size paper. |
| no matter how small, when we are immersed in the | | | | Keep wording precise and simple while avoiding |
| non-stop world of the OR. Observations of work in | | | | unnecessary clutter and coloring. |
| ICUs show a rate of error for around 1%, or an | | | | Turn the brain on. The checklist must help you turn |
| average of two mistakes per patient! | | | | your brain on when you are using it. A checklist is not a |
| What checklists should we adapt? The WHO Safe | | | | replacement for a brain. |
| Surgery Checklist is one of them, check. How about a | | | | Test the checklist. There is a very good chance |
| checklist for the Pre-Surgery department to ensure | | | | that your first draft will need revision. Do not be |
| that every patient receives all the necessary care and | | | | discouraged, but correct it and try again. |
| talks to every required clinician before being wheeled | | | | Healthcare around the world is at a crossroads, |
| to the OR? What about a checklist to ensure that | | | | evolving from a craftsman-style delivery of care to |
| every patient has all the necessary documentation | | | | the creation of an integrated healthcare delivery |
| before the day of Surgery? How about a checklist for | | | | system. This change is necessary, both to improve |
| the OR Suite changeover? The opportunities are vast, | | | | patient outcomes and to reduce costs that are |
| once you put your mind to it. | | | | growing at an unsustainable rate. The use of checklists |
| Clinicians and OR Nurses are not opposed to | | | | will be a powerful tool in this transformation. Being left |
| checklists or other tools for standardizing work. They | | | | behind is entirely up to you. |