Basic principles of checklists

Here are some basic principles to bear in mind when defining checklists. Use this checklist as you create checklists of your own!

Many of these ideas come from the most excellent book The Checklist Manifesto by Atul Gawande, which everyone should read.

It assumes expertise: it talks the user's language and assumes they know what it is talking about (though supplementary explanations are OK if necessary). The checklist is there to prevent errors of omission not errors of ignorance.

. Don't write a checklist for a wide subject area ("Change checklist").

In the title,

A checklist used during a single procedure is called a READ-DO checklist: read out an item, do it, check it off.
A checklist used at a point in time or "pause point" in a procedure is a DO-CONFIRM checklist: do what you need to do, then pause to confirm them all on the checklist.
To those categories I'd add a CHECK-CONFIRM category, used in assessment and audit to ensure all accountabilities, capabilities, controls and activities are in place.

Rules of thumb: no more than ten items, or one minute to perform the check.

Some people crave completeness: don't try to put everything in. The Checklist of Checklists says the items should be:

  • A critical safety step and in great danger of being missed?
  • Not adequately checked by other mechanisms?
  • Actionable, with a specific response required for each item?
  • Designed to be read aloud as a verbal check?
  • One that can be affected by the use of a checklist?

To establish a checklist

  • Create a process to capture knowledge for checklists
  • Store checklists in your knowledgebase (got one of those, right?)
  • establish accountability for each checklist - this is the hard part
  • Train people in what is there, how to find them, and how to use a checklist.
  • review and enforce use
  • Watch the improvement.
  • Feed back results.
  • Capture learnings to improve, including improving checklists

For more information on how to do checklists, see a Checklist for Checklists from Dr Gawande. There are some good examples of medical checklists there too.