Use this Check List or People Die

"Hyperbole?!" "Too dramatic!" "Oh, come on!" These are common reactions I get when I talk about the benefits of using checklists. Okay, no one actually says these things, but their rolling eyes and bored expressions carry the same meaning. But checklists are one of the most powerful tools consistently ignored by many companies. Let me prove it...

Perhaps you have heard of the work of Dr. Peter Pronovost, a critical-care specialist who has become an evangelist for the use of checklists in hospitals. He has shown that using checklists saves lives and money.

Hospitals have long struggled with the fact that patients can die because they contract infection after they check in. Within the first three months of using Dr. Pronovost's checklists, one hospital in Michigan reduced deaths caused by infection to zero! The results from a study of hospitals in Michigan, called the Keystone Initiative, estimated that using checklists saved more than 1,500 lives and $75 million in the first 18 months. Certainly in this case, it is no empty claim — use this checklist or people die!

If checklists are so powerful, why are they so underused? From my experience, resistance comes first from a lack of understanding about the impact checklists can have on an organization, and second from the perception that checklists are beneath us.

The most common responses I hear when it comes to checklists are:

• They are too simplistic
• They are too obvious
• We already know what to do

The most common attitudes behind the comments are:
• They will not make much difference
• We are too good to need checklists

Benefits of Using Checklists
It is because they are so simple that they are so powerful. Checklists provide consistency and assurance. They guarantee essential actions are taken, which allow people to apply judgment in areas where they can add the most value.

When we know that the essentials of any process are covered it frees up space in our brains so we no longer need to assume the responsibility of that task. This reduces our stress and increases our concentration.

A checklist communicates priorities. Dr. Pronovost found that doctors and nurses often are not doing what they know they should be doing. I believe that the reason, in part, is that in a stressful, fast-paced environment, it is easy to rationalize that skipping a step will not make a difference. Commitment to a checklist eliminates the possibility of independent judgment of priorities.

Check list Benefits
Easy, fast, low cost way to:
• Improve quality
• Reduce risk
• Save time
• Encourage a team environment
• Create consistency
• Establish a baseline for improvement
• Communicate priorities

Using checklists promotes teamwork, especially if the team has been involved in creating the checklist. Checklists in hand, nurses are now able to remind, if not direct, doctors about procedure. The checklists clarify what is essential and come with the expectation that the team will complete them.

Checklists create consistency. When a change occurs in a process controlled by checklists, the cause of the change is much easier to diagnose. In the same way, it is easier to see if suggested improvements to the process will actually have a desired outcome.

In fast changing environments, such as during periods of high growth, checklists and their cousins, guidelines, and procedures, are essential to maintaining quality and efficiency. Without them people are forced to come up with their own ad-hoc methods, which often results in redundancy, errors, and omissions of critical steps.

How to set up a check list
1. Target areas that are under performing
2. Establish a bench mark for improvement
3. Document the sequence of tasks for each person involved
4. Prioritize each task and identify those that are essential
5. Identify every area where a decision is made or judgement is required
6. Implement a check list and measure results
7. Create a check list for future edits to the check list. Don't assume you will get it right the first time.

Implementing checklists, while straight forward, is not as simple as just asking everyone to make a checklist for their job. Expect resistance, there always is. It requires a commitment to see the project through, but hopefully by now you are convinced it is worth it.

Oh, by the way, several hospitals in Minnesota have begun using checklists like the ones sited in the Keystone Initiative, so who knows, perhaps a checklist may one day save your life.

If you would like to talk about improving procedures in your business call 952-896-0062