Checklist ManifestoHow a checklist can boost efficiency and reduce mistakes

Atul GawandeAmerican surgeon, writer, and public health researcher. Practices general and endocrine surgery in Massachusetts.

Author of The Checklist Manifesto, Being Mortal, Complications, and Better.

Source:https://en.wikipedia.org/wiki/Atul_Gawande

“The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

- Atul Gawande

Two Reasons of Failure1. Ignorance- Science has given us only a partial understanding of the world and how it works

2. Ineptitude- Knowledge exists yet we fail to apply it correctly

Examples in Healthcare

• Ignorance- In the 1950’s, heart patients were put on bed rest for weeks in order to avoid strain to heart

• Ineptitude- In 2006, only 50% of hospitals achieved proper testing for heart attack patients undergoing cardiac balloon therapy that needed completion within 90 minutes after arriving at hospital

Checklistscanfillthegapbetweenerrorandsuccessrate

“The checklist cannot be lengthy. Keep it between five and nine items, which is the limit of working memory.”

- Atul Gawande

PATIENT HAS CONFIRMED• IDENTITY• SITE• PROCEDURE• CONSENT

SITE MARKED/NOT APPLICABLE

ANAESTHESIA SAFETY CHECK COMPLETED

PULSE OXIMETER ON PATIENT AND FUNCTIONING

DOES PATIENT HAVE A:

KNOWN ALLERGY?NOYES

DIFFICULT AIRWAY/ASPIRATION RISK?NOYES, AND EQUIPMENT/ASSISTANCE AVAILABLE

RISK OF >500ML BLOOD LOSS (7ML/KG IN CHILDREN)?NOYES, AND ADEQUATE INTRAVENOUS ACCESS AND FLUIDS PLANNED

NURSE VERBALLY CONFIRMS WITH THETEAM:

THE NAME OF THE PROCEDURE RECORDED

THAT INSTRUMENT, SPONGE AND NEEDLECOUNTS ARE CORRECT (OR NOTAPPLICABLE)

HOW THE SPECIMEN IS LABELLED(INCLUDING PATIENT NAME)

WHETHER THERE ARE ANY EQUIPMENTPROBLEMS TO BE ADDRESSED

SURGEON, ANAESTHESIA PROFESSIONALAND NURSE REVIEW THE KEY CONCERNSFOR RECOVERY AND MANAGEMENT OF THIS PATIENT

SIGN IN

CONFIRM ALL TEAM MEMBERS HAVEINTRODUCED THEMSELVES BY NAME ANDROLE

SURGEON, ANAESTHESIA PROFESSIONALAND NURSE VERBALLY CONFIRM• PATIENT• SITE• PROCEDURE

ANTICIPATED CRITICAL EVENTS

SURGEON REVIEWS: WHAT ARE THECRITICAL OR UNEXPECTED STEPS,OPERATIVE DURATION, ANTICIPATEDBLOOD LOSS?

ANAESTHESIA TEAM REVIEWS: ARE THEREANY PATIENT-SPECIFIC CONCERNS?

NURSING TEAM REVIEWS: HAS STERILITY(INCLUDING INDICATOR RESULTS) BEENCONFIRMED? ARE THERE EQUIPMENTISSUES OR ANY CONCERNS?

HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVENWITHIN THE LAST 60 MINUTES?YESNOT APPLICABLE

IS ESSENTIAL IMAGING DISPLAYED?YESNOT APPLICABLE

TIME OUT SIGN OUT

Before induction of anaesthesia Before skin incision Before patient leaves operating room

SURGICAL SAFETY CHECKLIST (FIRST EDITION)

THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.

Checklist only:Layout 1 16/6/08 18:01 Page 1

Atul Gawande’s Surgical Checklist used to reduce morbidity and mortality in the Global population

“Good checklists are precise. They are efficient, to the point, and easy to use even in the most difficult situations. Good checklists are, above all, practical.”

- Atul Gawande

Benefits of ChecklistsüEnsures consistencyüUsed to reduce failureüAids in memory and

üInformational aidüCompleteness when

attentioncarrying out a task

How Healthcare Checklists have Improved

https://www.goodreads.com/author/quotes/3078.Atul_Gawande?page=5

5-Pointchecklistreducedlineinfectionsfrom

10%to0

“One essential characteristic of modern life is that we all depend on systems—on assemblages of people or technologies or both—and among our most profound difficulties is making them work.”

- Atul Gawande

In the Workplace…

üEmployees feelaccountable for performing inspections because there is a written record

üWorkers feel organizedwhen provided guidelines on inspections

“Just ticking boxes is not the ultimate goal. Embracing a culture of teamwork and discipline is.”-Atul Gawande

Source:https://inspectioneering.com/content/2016-05-23/5360/instilling-a-checklist-culture-to-improve--asset-integrity-manag

FacilityChecklistBenefits

ProcessReliability- Taskscompletedcorrectlythefirsttimedecreasingre-work

VerifiableCompliance-Targetspecificstepsofaprocessforimprovementincreasingworkeraccountabilityandqualityassurance

OperationalInsight- Discoverassetdatatoidentifyandcorrectnon-productivetimeandimproveoncost

BestPracticeCapture- Identifywhat’sworkinginfacilityandreplicateincreasingproductionefficiencies

Could Your Industry Benefit from aChecklist?

“We know the patterns. We see the costs. It’s time to try something else. Try a checklist.”

- Atul Gawande