Embracing The Checklist

I start them for one-off tasks (Vacation Packing) and I have standing ones for recurring chores (Supermarket — which I share with my wife so we don’t buy four gallons of milk). I leverage them to get my kids to camp with the right stuff (Camp Backpacks) and I live and die by them for work (Live Webinar). I’ve got dozens of them with a few steps each on my iPhone Reminders app and I have a few with dozens of steps in Microsoft OneNote.

They are, of course, checklists, and they keep me going.

Perhaps it was having a German mother — who loved process and punctuality as if intentionally living out the stereotype of her folk — that destined me to be a checklist guy, or perhaps it was just some ingrained love of efficiency that made me want to get sharper and sharper at executing the things I had to do over and over again. Regardless, my love of checklists is true, and I believe it’s been a key part of any success I’ve had.

Everyone in business, in healthcare, in any type of endeavor where there is competition, needs a “way” of doing what they do; a formula that allows them to be make fewer errors and scale better than the other guy, and that is what checklists do. They allow you to scale up without the whole thing breaking down because you can’t remember each of the 39 steps that need to be done for a process you do every week. And even if you could manage to remember them, chances are you wouldn’t get the exact order right every time. And perhaps most importantly, even if you could remember all 39 in the right order, you wouldn’t have a good, secure way to inject a step somewhere in the middle and have it be there for next time. You wouldn’t have a reliable way to make the recipe better, with the result that you’d eventually forget something and go back to the bad old way. You wouldn’t have a learning system.

And that’s what David Blumenthal, MD, former National Coordinator for Healthcare IT, always talked about. How do we take near misses and sentinel events, and leverage technology to ensure the entire healthcare system knows what just happened? How do we learn from our mistakes and move forward smarter than before?

As John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, recently wrote, it’s checklists that help process, and the gradual improvement of those checklists over time which can result in systemic improvement. “Many complain that electronic health records create burden without significant benefit. Implementing checklists into the workflow of EHRs in the operating room is high value, ensuring good team communication, while also reducing error. A win/win for everyone!”

This is, of course, not big data stuff, not some Watson-like computer running complicated algorithms that can kick your butt at chess. It’s simple common sense — you don’t get to hurtle that plane carrying 200 people down the runway unless every box is checked off, and you don’t get to use that scalpel on one single person unless the same condition has been met. It’s scalable, simple, repeatable and it works; and, of course, it’s much easier in an electronic format (OneNote is brilliant).

So before you go big, make sure you play some small ball by harvesting the low-hanging fruits that are living, breathing and learning electronic checklists. I’m sure none other than Atul Gawande, author of “The Checklist Manifesto” would agree.