Can Our Work Lives Use Some Organizing?

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In his bestselling book, The Checklist Manifesto: How to Get Things Right, surgeon Atul Gwande writes, “We have accumulated stupendous know-how…and with it we have accomplished extraordinary things. Nevertheless…avoidable failures are common and persistent…We need a strategy for overcoming failure…that takes advantage of the knowledge people have but makes up for our inadequacies…

Such a strategy—although it will seem almost ridiculous in its simplicity—is a checklist.”

The concept of using checklists to manage complicated situations is also making its way into popular culture. In the season finale of “Grey’s Anatomy,” Dr. April Kepner saves the day by overcoming the resistance of her colleagues and coming up with a checklist system to treat the victims of a plane crash. (She learned her lesson when a patient died after missing a single step.)

The Origin of the Checklist
In 1935, U.S. Air Force crews created the first pilot’s checklist to ensure that take off, flight landing, and taxiing were performed in a safe and routine manner. Today, those checklists are still used by pilots and air traffic controllers, regardless of how many times they had previously carried out these standardized activities.

In medicine, remarkable reductions in infection rates in ICUs and surgical mortality have been attributed to the use of checklists. Checklists support the standards of care by providing specific steps to be followed for every patient. As a result, medical errors that occur due to lapses in concentration, distraction, or fatigue are decreased.

Checklists and the Veterinary Team
Human error is inevitable. In veterinary medicine, chaos doesn’t occur only within the treatment area; the front desk can get slammed with telephones, drop-offs, and patients checking in for appointments. The boarding service experiences peak periods when the kennel is filled to capacity with a mix of healthy and medical boarders. An in-house grooming salon may have multiple groomers who all rely on one another to leave the salon in impeccable condition for the next day’s groomer.

Sometimes a simple solution to coping with busy environments is the best solution. A well-organized checklist provides a straightforward method for standardizing our work processes by helping us complete necessary tasks without risk of omitting a crucial step.

In our industry, the patient interacts with multiple team members and experiences multiple clinical and customer service processes. Risk for failure due to memory, attentiveness, or thoroughness is caused by interruptions, distractions, insufficient training, lack of time, and other reasons. In short, mistakes due to oversight can occur at any time during any patient visit. Checklists are designed to help protect us against such failures.

Using Checklists
At our hospital, each area uses checklists to help verify consistency in team performance. When an error does occur, as the practice manager, I go to a checklist to see which team member checked off a step as completed. This gives me the basis for opening up dialogue with staff to determine whether we have a training issue or a performance issue. The checklists also provide me with additional documentation to support the review assessments used during formal job performance reviews.

Possible applications for using checklists include:

•  When collecting client emails to move to a total client email reminder program, create a checklist detailing which information needs to be captured to assist the client service team in gathering data.
•  In a department where all team members are not equally proficient, use a checklist to rotate staff into all areas of work to strengthen all team members’ performance.
•  In the grooming department, use a checklist to prepare the salon for the incoming groomer to ensure that OSHA regulations are being followed and all supplies are restocked.
•  Use a surgery preparation checklist to ensure protocols are followed and patients are fully prepared so the surgeon is confident that the patient is ready for the surgical procedure.

Resistance to Checklists

When critical care researcher Dr. Peter Pronovost of Johns Hopkins University developed a system to remind physicians of steps to take to reduce medical errors and infections, he discovered 3 primary reasons for resistance to the use of checklists:

1. Some physicians were insulted, feeling that the use of checklists was a reflection on their capabilities.
2. Staff believed they were already too busy.
3. Such “mundane” research was ignored in favor of the more “exciting” issues.

Pronovost fought the resistance by appealing to a value they all shared—patient health, a value that is equally applicable to veterinary medicine.

Though everyone’s situation may be different, at Natick Animal Clinic we use standard checklists for these areas:

• Morning routine
• Closing routine
• Check-in process
• Patient monitoring pre- and postsurgery

Keep in mind for checklists to be useful, there must be a balance between concision and efficiency. Longer lists don’t mean better lists.

Checklists for Your Clinic
Wondering how to get started? Use the checklists from our clinic and our sister clinic (Have A Heart Animal Hospital) as a guide.

Kennel Closing Checklist
Treatment Log
Surgery/Anesthesia Log

Plus, download additional checklists at myEVT.com/magazine.