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The Checklist Manifesto: How to Get Things Right
Book Review: The Checklist Manifesto: How to Get Things Right By Atul Gawande © 2009 by the author. Metropolitan Books, an imprint of Henry Holt, New York, NY. ISBN-13: 978-0-8050-9174-8
Reviewed by Susan V. White, PhD, RN, CPHQ, FNAHQ, NEA-BC, Chief of Quality Management at the Orlando VA Medical Center, Orlando, Florida
T
he Checklist Manifesto opens with a heartwarming story of a little girl who drowns but after intense treatment has a successful outcome. This opening was hardly this reviewer’s expectation for a book about checklists. Dr. Gawande uses the drowning story and other scenarios to explore the complex and complicated aspects of modern medicine and illustrate how a simple tool can assist in managing complex care. The checklist is an often underused and underappreciated tool that integrates a variety of concepts. Defining a checklist somewhat differently than usual, Dr. Gawande describes it as both a task and a communication check. If you expect to see something similar to the World Health Organization’s Safe Surgery Saves Lives Surgical Safety Checklist for which Dr. Gawande is noted, you will be surprised. The Checklist Manifesto describes key conceptual practices and principles associated with the use of checklists that embody basic patient safety and quality management principles. Though the author does not present this book as a primer on patient safety, the practices are clearly integrated into the stories and examples. Just as a cooking recipe provides a standardized method for creating a specific dish, the checklist provides a step-by-step method for creating consistency, but it also allows expertise and ability to adapt in unexpected situations. You will read about patient-safety concepts with the focus on teamwork and the ability of any team member to stop the line if something on the checklist is not correct. The Joint Commission’s concept of a “time out” is described by the author as “pause points” to ensure the team is actively, not passively, engaged in the process of following the checklist. The author also describes the concept of using huddles before surgery or preparing to respond to uncertain, or unexpected but possible events, which has been incorporated into many safety programs. The use of forcing functions to ensure that a specific action is taken is described as an important method to strengthen the use of checklists. Other
64
Journal of Nursing Regulation
key safety principles address our limited ability to recall and the use of a checklist as a memory aid for essential steps in a process. The author weaves personal examples from medicine, construction, aviation, and finance regarding the application of checklists and the ability of checklists to increase success and reduce risk. The power of the checklist to verify that specific measures were completed is illustrated in examples of reduced infection rates through the use of preventive bundles, successful building projects, safe plane landings, and strong financial portfolios. Dr. Gawande also describes the challenges of implementing a checklist in these different fields with a key focus on health care. Of interest is his work with Daniel Boorman of the Boeing Company in Seattle. From this chapter, the reader will learn what makes a good checklist based on years of work in the aviation industry. A good checklist is precise, simple, and exact. It cannot be too long and ideally should fit on one page. A checklist is not intended as a comprehensive guide, so making a checklist simple, usable, and systematic takes work. Also, testing is required to be sure the tool works consistently. In aviation, testing can be performed in a flight simulator; in health care, testing can be performed in one hospital operating room. The checklist should be in the familiar language of the profession, so a surgical checklist must have the same meaning to the surgeon, anesthesia provider, and nurses. The tips describe the checklist format as being free of clutter and recommend both uppercase and lowercase text and a sans serif font. Based on aviation checklists, two basic formats exist: Do-Confirm and Read-Do. The author warns that the checklist is not a foolproof tool that everyone must use and notes that the checklist must be supported by a team approach and verbal confirmation of action. The Checklist Manifesto is an interesting read on simplifying complex situations through the use of the checklist tool. The subtitle says it all: “How to get things right.”
Reviewed by Susan V. White, PhD, RN, CPHQ, FNAHQ, NEA-BC, Chief of Quality Management at the Orlando VA Medical Center, Orlando, Florida
T
he Checklist Manifesto opens with a heartwarming story of a little girl who drowns but after intense treatment has a successful outcome. This opening was hardly this reviewer’s expectation for a book about checklists. Dr. Gawande uses the drowning story and other scenarios to explore the complex and complicated aspects of modern medicine and illustrate how a simple tool can assist in managing complex care. The checklist is an often underused and underappreciated tool that integrates a variety of concepts. Defining a checklist somewhat differently than usual, Dr. Gawande describes it as both a task and a communication check. If you expect to see something similar to the World Health Organization’s Safe Surgery Saves Lives Surgical Safety Checklist for which Dr. Gawande is noted, you will be surprised. The Checklist Manifesto describes key conceptual practices and principles associated with the use of checklists that embody basic patient safety and quality management principles. Though the author does not present this book as a primer on patient safety, the practices are clearly integrated into the stories and examples. Just as a cooking recipe provides a standardized method for creating a specific dish, the checklist provides a step-by-step method for creating consistency, but it also allows expertise and ability to adapt in unexpected situations. You will read about patient-safety concepts with the focus on teamwork and the ability of any team member to stop the line if something on the checklist is not correct. The Joint Commission’s concept of a “time out” is described by the author as “pause points” to ensure the team is actively, not passively, engaged in the process of following the checklist. The author also describes the concept of using huddles before surgery or preparing to respond to uncertain, or unexpected but possible events, which has been incorporated into many safety programs. The use of forcing functions to ensure that a specific action is taken is described as an important method to strengthen the use of checklists. Other
64
Journal of Nursing Regulation
key safety principles address our limited ability to recall and the use of a checklist as a memory aid for essential steps in a process. The author weaves personal examples from medicine, construction, aviation, and finance regarding the application of checklists and the ability of checklists to increase success and reduce risk. The power of the checklist to verify that specific measures were completed is illustrated in examples of reduced infection rates through the use of preventive bundles, successful building projects, safe plane landings, and strong financial portfolios. Dr. Gawande also describes the challenges of implementing a checklist in these different fields with a key focus on health care. Of interest is his work with Daniel Boorman of the Boeing Company in Seattle. From this chapter, the reader will learn what makes a good checklist based on years of work in the aviation industry. A good checklist is precise, simple, and exact. It cannot be too long and ideally should fit on one page. A checklist is not intended as a comprehensive guide, so making a checklist simple, usable, and systematic takes work. Also, testing is required to be sure the tool works consistently. In aviation, testing can be performed in a flight simulator; in health care, testing can be performed in one hospital operating room. The checklist should be in the familiar language of the profession, so a surgical checklist must have the same meaning to the surgeon, anesthesia provider, and nurses. The tips describe the checklist format as being free of clutter and recommend both uppercase and lowercase text and a sans serif font. Based on aviation checklists, two basic formats exist: Do-Confirm and Read-Do. The author warns that the checklist is not a foolproof tool that everyone must use and notes that the checklist must be supported by a team approach and verbal confirmation of action. The Checklist Manifesto is an interesting read on simplifying complex situations through the use of the checklist tool. The subtitle says it all: “How to get things right.”