Checklists are everywhere. You might even have a couple on your phone right now. They are a simple tool: great for grocery lists and your daily to-dos; easy to make; and oh so satisfying to check off. But how much do you use them in your practice? Checklists pack a powerful punch, and they may be just what your practice is missing.
Many in medicine deem checklists to be too simple a tool. In his book The Checklist Manifesto, Atul Gawande, MD, MPH, a general surgeon and professor at Harvard Medical School, says:
It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us—those we aspire to be—handle situations of high stakes and complexity.The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating.
Gawande is among a growing number of physicians who argue that medicine has become too complex to manage using one’s own expertise and memory alone. In his book, he shows how the implementation of checklists in high-stakes areas of medicine like the ICU and surgery have saved time and lives.
He compares the sophistication and complexity of medicine today to that of the aviation industry and the building of skyscrapers, where checklists are integral to success. He says:
It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals. And by remaining swift and usable and resolutely modest, they are saving thousands upon thousands of lives.
With the help of Gawande, the World Health Organization (WHO) created the Surgical Safety Checklist which has been successfully implemented in hospitals around the world. WHO Patient Safety is currently collaborating with other disciplines to develop checklists in other areas of medicine.
The use of checklists in practice has been successfully adopted by radiology and anesthesiology, but little is written about their use in other areas—like neurology. But that doesn’t mean they wouldn’t be useful. The field of medicine just has a tendency to adopt new ideas more slowly. But, because checklists are such a simple tool to create, you can choose to start using them right now.
The key to implementation, says Gawande, is not to tackle an entire practice but rather to solve one problem at a time. For example, in the ICU at Johns Hopkins a simple five-step checklist was set up just to prevent line infections. After a year of implementation, says Gawande, “the ten-day line-infection rate went from eleven percent to zero.”
Checklists can not only improve patient safety and outcome, they can also be used to increase efficiency and save time. For example, patient procedures can be carried out more quickly if your staff has an equipment-prep checklist to get things ready for you. Even if you don’t have the staff to help, using a checklist yourself means you are less likely to have to hunt around for something you forget mid-procedure. And in today’s insurance climate, time is money.
Speaking of insurance. Checklists can go a long way toward making sure your staff doesn’t miss a single step in the billing and reimbursement process. Even though checklists are not ubiquitous in neurology practice, you can easily find them for all aspects of practice management in general:
- Here is a New Practice Checklist, created by the Harris County Medical Society.
- Here is a Cybersecurity Checklist for The Small Healthcare Environment, at HealthIT.gov.
- Here is a book, Tools for an Efficient Medical Practice: Forms, Templates, and Checklists, produced by the American Medical Association.
If you would rather create your own, check out this guide What Makes a Good Checklist, created by the Department of Health and Human Services.
As a neurologist in private practice, your job is hard enough. You have to be an expert in your field, and you have to master the myriad tasks required to run a business. “Under conditions of complexity,” says Dr. Gawande, ”not only are checklists a help, they are required for success.”