Checklists In Complex Systems

July 31, 2012

In his book The Checklist Manifesto, Dr. Atul Gawande made a compelling case for the value of checklists in complex systems. Dr. Gawande correctly observed that checklists are routinely used in aviation to mitigate risk and improve safety. Pilots use checklists extensively for a reason. Flying an airplane is a complex endeavor and things can get missed if one relies on memory – especially when things get stressful. There is a phenomenon called “task loading” that means there are just so many things one can attend to and respond appropriately before something gets missed. Even for things like routine landings, even private pilots use a short checklist to be sure several key things don’t get missed. Mine is the acronym GLUMPS which stands for Gas, Lights, Undercarriage, Mixture, Prop, Seatbelts. I go through this checklist every time I land and it has helped me remember things I would have otherwise missed.

Dr Gawande wondered whether the use of checklists would yield similar safety improvements in healthcare. The answer was yes. In surgical suites, emergency departments and even on hospital wards where “routine” care is delivered, the use of checklists has saved lives and improved safety. The readers of this blog know that healthcare is rife with health care errors and will appreciate it if anything as simple as a checklist can improve care.

So, what does this have to do with behavioral healthcare? As we move into the new world of Evidence Based Treatments, Health Homes and Accountable Care, our industry is being held to increasingly higher levels of accountability. We have correctly identified the importance of primary care and we will be responsible for the coordination of care if not the actual provision of those medical services. In short, the services we provide are becoming more structured and our world is getting more complex. As Dr. Gawande has noted, …Under conditions of complexity, not only are checklists a help, they are required for success. Where would this fit in our world? For those of you that do crisis intervention work, you probably already have structured protocols, and possibly checklists, in place.

In what other ways are checklists used in our industry? I’d like you to tell me. If you will send in examples of you checklists, Netsmart will review them and for the most creative use of checklists, we will send you a gift card for $50. We will want to share all the submissions online so others can benefit from the work you’ve done, so if you don’t want it shared, don’t send it in.

Atul Gawande (born on November 5, 1965 in Brooklyn, New York, USA) is an American physician and journalist. He is known in the public arena as an expert on reducing error, improving safety, and increasing efficiency in surgery. He serves as a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, Massachusetts and associate director of their Center for Surgery and Public Health. He is also an associate professor at the Harvard School of Public Health and an associate professor of surgery at Harvard Medical School. He has written extensively on medicine and public health for The New Yorker and Slate[1] and is the author of the books Complications, Better, and The Checklist Manifesto. Source: Wikipedia