A Life-Saving Checklist (2007)

I am an avid checklist user. I have a number of complex processes which are repeated monthly, quarterly or yearly. When the office is calm and I am feeling good I don't need them and find myself ticking them off having already done the stage. When I am feeling less-good, the office is noisy and I keep being interrupted the check-lists are the reason I succeed.

Yet still I find almost complete resistance to them by colleagues. They seem to think it is somehow demeaning to reduce their work to a fixed process. Perhaps it takes the mystique out of it, and gives the idea that anyone could do it.

In some sense this makes sense in capitalism:

If you simplify your job, everybody could do it, and the salary and job security would go down.

this is a very well written book and one I think of often...

Only if the job really could be done by anybody. Pilots use checklists for basically everything, but I don't think there's a widespread belief that the pilot could now be replaced by J. Random Passenger. The point of a checklist isn't necessarily to completely remove any thought or training from a process, but to ensure that every critical step is performed in the proper order.

I think a key element of checklists, and checklist discipline, is coordination between members of a team. What checklists allow you to do is have accountability across differences in experience/authority/expertise and also track a process over time.

In my work as a naval aviator (caveat, I'm still a student), we use checklists in the cockpit to coordinate all sorts of functions such as engine start, takeoff, landing and emergencies. These ensure that we start the engine the same way, verify we are ready for landing, and also handle emergency procedures in an approved way. When there are rank and experience differences in the cockpit these checklists help equalize the disparity, and let less experienced or junior members hold senior members accountable. Before each flight we also follow a briefing checklist, and that includes human factors such as any possible issues relating to illness/medication/stress/alcohol/fatigue/eating. Doing so ensures that there is always a place for people to vocalize anything that the team should know.

Previously I worked on a Coast Guard cutter, and we used similar checklists to ensure we were prepared to get underway, enter port, or complete a complex evolution like tow another vessel. For these checklists the main value was in verifying between multiple changes of team personnel that everything was being completed to meet the timeline. The checklist served as documentation that the person before you had collected the necessary information, made proper notifications, and started/finished processes.

It has baffled me when I hear that medical personnel dont use checklists for these exact reasons. They perform time critical, high stress procedures that have a fairly documented set of steps. They require a team of personnel that have different scopes of expertise, experience, and authority. There are frequently changes in the team's composition over the duration of the patients care, and it seems like the patient will be handed off between different teams that specialize in their own respective areas of patient care. For us in the military it is pretty easy for authority to mandate we use checklists, and the buy in come from accident investigations revealing that checklists were ignored or skipped. Is there an equivalent medical authority that can pass this information down, or does this have to emerge independently from each hospital system?