With the level of change the NHS faces, it is crucial to keep everyone focused and on target.
At times of uncertainty, simple measures are best. Enter the humble checklist. On an organisational and individual basis, a checklist is a systematic way to ensure healthcare quality and safety.
Intensive care specialist Peter Pronovost believes checklists can be applied anywhere there is a need to improve knowledge and ensure that preventable harm and costs are exactly that - preventable.
“Everything you do, every decision you make, is based on the knowledge you have about the subject,” says Dr Pronovost, co-author of Safe Patients, Smart Hospitals: how one doctor’s checklist can help us change health care from the inside out.
“If you don’t have access to all the information, you have a clear disadvantage,” he says.
Dr Pronovost tested his first checklist for medicine in 2001 - a simple sheet with five steps for doctors in his hospital’s intensive care unit to follow for the placing of central venous catheters, a common but vital procedure. The results were astounding: after 15 months, the hospital saved about $2m and prevented 43 infections and eight deaths.
There is so much specialised knowledge and expertise in the medical profession that it is impossible for a single doctor to do all the work or make every call, which makes task lists and co-ordination lists and troubleshooting lists completely necessary.
Dr Pronovost believes his checklist theory can be applied to any situation where knowledge is linked directly to performance.
“It’s all about creating an efficient method to tap the ‘wisdom of crowds’ sharing information, making sure everyone has all the tools they need to do the best job and make the best decisions,” he says.
“Obviously there is no way to completely prevent negative outcomes, but it is imperative that you have access to all the tools and information available.”
NHS checklists - whether it is guidance to promote the safe, secure and effective use of controlled drugs or the steps to complete a breast cancer screening procedure - are essential, but it can be easy to forget the importance of following simple guidelines when you are so familiar with a process. If a stage is missed, negative outcomes can creep in. That is why it is crucial to stick to a structure and remain focused and on target.
Encouraging your staff to keep their own, informal, personal to-do lists can help. The to-do list is a staple of every time management regimen going back at least to the “first American” Benjamin Franklin, who began his daily checklist with: “Rise, wash, and address Powerful Goodness! Contrive day’s business, and take the resolution of the day; prosecute the present study, and breakfast. Question. What good shall I do this day?”
Almost all of us try to keep to a regimen, and the fact that we usually fail at it does not make it any less useful. The question is when it is appropriate to move from entirely personalised list-making to the more formal checklists.