The messy complexity of successful checklists
Shamelessly quoting from my own paper that addresses the frustrating oversimplification of the "checklist" narrative.
"There is no question that the right checklist, in the right place, with the right design and implementation, can be used enthusiastically by the right people with the right skills and can be highly effective. Yet, in translating checklists from aviation and other industries to healthcare, we may have misunderstood their strengths, failed to design them based on well established principles and failed to engineer them as a component of a wider socio-technical system. We have made assumptions about their use, effectiveness and ‘evidence base’ that are readily and easily challenged, and have defined compliance criteria and penalties based on assumptions that may not reflect how they contribute to better outcomes. The superimposition of teamwork and communication— without specifically providing training for those skills, or indeed the sociocultural support for them— further contributes to the difficulties in successful implementation.
A checklist is a complex socio-technical intervention that requires careful attention to design, implementation and basic skills required for the task. Understanding and specifying these mechanisms of effect with greater precision would enable us to move beyond the moot ‘checklists do/don’t work’ commentaries."
- Catchpole K, Russ S. BMJ Qual Saf 2015;24: 545–549.
Competing interests: No competing interests