Checking the Checklists for Patient Safety

What is a checklist and how important is it for healthcare workers to have them when providing patient care? A checklist is a list of “to do” or “must be accomplished” things. In the healthcare setting, it is something we cannot do without. We have Dr. Peter Pronovost and Dr. Atul Gawande, pioneers of these checklists for patient safety, to thank for understanding the importance of a standard process. If not for their significant contribution, our lives as health workers would be a lot more stressful and complicated.

According to the World Health Organization, we utilize checklists to alarm us of possible errors before they can lead to negative consequences for the clients we care for.  It also provides the ground work for simplifying the complex tasks of providing patient care. Ticking all check boxes gives us reassurance that we have done our part and we deserve a pat in the back and a much deserved coffee break. It means our clients are receiving the best possible care.

What Do Patient Safety Checklists Mean for Health Care Workers?

First of all, a checklist is the mother of all organizational tasks. In the hectic and frantic world of doctors, nurses, therapists and other care providers, one cannot simply do a mental note of everything that is being done for the patient. We have charts, yes, but we cannot see from there if everything that is supposed to be done is really done. 

Secondly, when we have a list to be ticked, it’s easier to tell your team that you’ve done your part. Show them your checklist and expect a 5-star rating!

With these lists, accomplishments are tangible. 

Is There a Downside to Utilizing Checklists?

As much as checklists are crucial part of patient safety interventions, there are downsides to their use. In a hospital setting, for example, where not-so-ideal work relationships are apparent between team members horizontally and vertically in the hierarchy, checklists only serve as a common ground for interventions and goals. It doesn’t take into account relationship dynamics. It puts issues of power struggles out of the picture and leaves them unaddressed. 

The following is a fairly typical story: There is a team of health workers: a doctor, a head nurse, a staff nurse, two CNA’s, one respiratory therapist and one IV therapist. One member of higher hierarchy has an aggressive behavior. He or she lashes out at other team members, degrades others in the team and is not open to suggestions. He or she asserts the completion of checklists as of utmost importance, disregarding fatigue of team members during staff shortages, or the limitations of resources. 

Three members from lower in the hierarchy oblige and comply. One of them projects her frustrations to a co-worker, purposely misleading her and pointing out what needs to be done.

The result: the checklist is accomplished, but tension among team members is left to escalate. 

For some teams, they can overcome weaknesses in relationship dynamics. But not all toxic work relationships are healed, and when they are not, they manifest somewhere. Patient care may be affected, a crucial team member leaves, staff illnesses and absences become frequent and more errors are committed.

This is what happens when the only focus is on completing what is written in a list: we get a false sense of accomplishment.

Working Around Checklists for Patient Safety

Use of checklists as a stand-alone technique in ensuring patient safety is not sufficient. Factors affecting its use should be considered and scrutinized to maximize their greatest advantage.

Organizations should also develop evaluations for checklist use, not only for patient benefit, but also for team relationship dynamics. Did the use of checklists improve safety outcomes? Was it successful in preventing and reducing errors? Did it create undercurrents among team members? How did the staff work on accomplishing what is stated in the lists?

When leaders recognize the importance of keeping good working relationships in the accomplishment of checklists, great things happen in the realization of patient safety goals. It is advantageous to consider team-building, ‘whole systems’ consulting, effective communication training and practice, and seminars that work on group dynamics, such as Medical Improv to foster more positive relationship dynamics during the use of checklists. 

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