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Curbside Consult with Dr. Jayne 7/15/13

July 15, 2013 Dr. Jayne 3 Comments

A Tale of Two Lists


I’ve been a big fan of making lists even before people like Atul Gawande raised the collective consciousness with The Checklist Manifesto. One of my former co-workers used to make fun of those of us who were “list-makers” and said that we lacked spontaneity and a certain sense of fun due to our fondness for lists. Personally, making lists has kept me sane.

There’s too much going on in most of the working world today and especially in healthcare. Everyone is trying to do much more (remember Meaningful Use?) with the same level of staffing or even less. People are overworked, under-inspired, and fatigued. These are factors that allow near-misses (or actual misses) for patients. Making lists helps one ensure nothing is forgotten and that every precaution was taken to ensure care was delivered as intended.

Checklists aren’t just for the front lines of patient care. I use one when I’m wearing my IT hat as well. They can be simple – I have a checklist I use before presentations to make sure I have e-mail, instant messenger, and other applications shut down so they’re not distracting. I make sure my desktop background is neutral and my screen resolution is adjusted.

They can be complex and multi-faceted. We use checklists extensively in our EHR implementation framework. They ensure that every user in every specialty and every practice setting receives consistent training. Signing the completed checklists after training documents the users’ receipt of training and has reduced the incidence of “nobody every showed me that” complaints to near zero.

I had a chance to revisit our training checklists today when one of our implementation specialists went out on family leave earlier than expected. With it in front of me, I was able to deliver solid training to a couple of specialists even though it’s been several months since I’ve covered their particular discipline. After the session, I made sure to compliment the implementation manager on ensuring that the lists are kept current and used consistently by everyone on her team.

She joked back at me that the training lists are the only ones that seem to be working for her right now. She’s in a bad cycle of making lists for implementation projects that continually get put on hold by the leadership. Once providers figure out that their pet projects are on hold, they raise a political ruckus and the projects are reactivated. She pulls up the lists and updates project plans, only to be put on hold again when the projects are not funded.

It’s a vicious cycle and to the point where she’s not even updating them anymore, just changing the date in the header. I don’t blame her. The best list in the world can’t be successful if no one is able to activate it and carry it through to completion. I think the leadership needs a better checklist to ensure projects are funded before trying to get them up and running. Or maybe they need a checklist for when they try to put them on hold, making sure they are not political hot potatoes before they are placed on hold.

How does your organization view checklists? E-mail me.


E-mail Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. Being an IT professional for many years, I have personal experience in regards to the last two paragraphs. Just reading those paragraphs gives me whiplash thinking about all those projects that were on and off the list over and over again.

  2. Integration uses a checklist and software inventory for every installation in our organization. We got team buy-in by allowing everyone to change the checklist (add or delete items) as often as users deem necessary. The only rule is that the checklist will never be longer than one page. The consequences of not using checklist for a bad installation: you’re on your own. Our team will pitch in and help anyone who used the checklist and also got in trouble. It is amazing how few of those events we experience. Sometimes new people have a problem adopting the process, but after a few smooth installs everyone seems to love it. It’s hard to argue with a stress-free implementation.

  3. The current clinical environment I am in is the ultimate in dysfunction–not a good thing, of course, but in an anti-matter sort of way helps to underline the value of best practice. In this case, correctional medicine, there are checklists. But they are drawn up by persons who do not actually care for patients or who have never stepped inside a secure environment. And checklists go against the very grain of the entire culture which derives its energy from the adrenal surge of repetetive crisis. How could you possible enjoy an urgency if you handled it well? A checklist would diminish the fun of seeing things go out of control. Not to mention deprive the chain-of-command of another blame-assigning opportunity and a chance to make the exiting checklist longer and more convoluted.

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