Warren Buffet doesn’t make an investment without one. Pilots don’t take a plane up without one. Yet many people are very reluctant to use the simple tool know as the checklist. Especially, it seems, in healthcare.

The checklist was developed by the U.S. Air Force decades ago to help pilots deal with the increasing complexities of aircraft. It began as a simple pre-flight walk around the plane and instrument check, a routine that private pilots do to this day. [See Checklist mentality… it’s a good thing from the Air Force Safety Center.]


Now hospitals are adopting checklists for many purposes, including surgery, where a simple 90 second checklist has cut the rate of fatalities dramatically. However, it is not exactly a welcomed addition. Acclaimed surgeon and writer Atul Gawande, who developed one checklist which cut surgical deaths nearly in half, surveyed staff at eight hospitals to get their impressions of the checklist. In his book, “The Checklist Manifesto,” he noted that 20 percent were absolutely opposed to it, claiming it was hard to use and wouldn’t improve safety.

However, when he asked how many would want the list used if they were undergoing surgery, a total of 93 percent said “yes.”

Another checklist, used in ICU’s in Michigan, decreased infections by 66 percent in three months and saved an estimated 1,500 lives over an 18 month period.

So why is there such reluctance to use this simple tool to deal with anever more complex world? Perhaps because we don’t like to admit we need a “crutch.” Giving in to the checklist is an acknowledgement that our brains aren’t capable of handling the complexity. Even it if means placing other lives in danger.

Yet it appears that our brains can handle the complex stuff, even with the proliferation of information and technology surrounding us. New stuff is usually pretty interesting. Learning it and using it forces us to focus very sharply. It’s the simple stuff that trips us up.
Checklists are used in the commercial and industrial sectors to save time and money. They can save lives as well.

Recently on the TeleTracking Blog we suggested a checklist that nurses can use to improve patient flow, even without capacity management automation. We hope it will be used to make their jobs a bit less chaotic and their patients a little happier. Look at it, improve it and send your suggestions back to us.

Don’t hate the checklist. It’s a cheap and simple way to institutionalize “best practices” and reduce the errors that make us all human.


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