Checklists in Healthcare: The Pros and Cons

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 the pioneers of these checklists, Dr. Peter Pronovost and Dr. Atul Gawande, to thank for. These physicians understood the importance of having a list as part of a standard process of providing care. 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 groundwork for simplifying the complex tasks of providing patient care. Ticking all checkboxes gives us reassurance that we have done our part and we deserve a pat on 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 make a mental note of all procedures done on the patient. A checklist can present every step or detail of a process.

Secondly, when we have checkboxes 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 records, accomplishments are tangible. 

Is There a Downside to Utilizing Checklists?

As much as checklists are a crucial part of patient safety interventions, there are downsides to their use. In a hospital setting, for example, where not-so-ideal work relationships exist among 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. The team leader has an aggressive behavior and lashes out at other team members. This person degrades others in the team and is not open to suggestions. He asserts the completion of checklists as of utmost importance while disregarding the fatigue of team members when the unit is short-staffed. Three members of the team oblige and comply. One of them projects his frustrations to other co-workers and purposely misleads them.

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 resigns, the employees take more leaves of absences, and medical errors become frequent.

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

Working Around Checklists for Patient Safety

The use of checklists as a stand-alone technique for ensuring patient safety is not sufficient. Factors affecting its use should be considered and scrutinized to maximize their most significant 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, true collaboration achieves patient safety goals.