Feature—Evolution of HSRThe checklist—a tool for error management and performance improvement
Introduction
Human error is inevitable—particularly under stressful conditions [1], [2]. It has been demonstrated that levels of cognitive function are compromised as stress and fatigue levels increase [3], as is often the norm in certain complex, high-intensity fields of work. This can lead to increased errors in judgment, decreased compliance with standard procedures, and decreased proficiency. Areas such as aviation, aeronautics, and product manufacturing, in which safety and precision are paramount in accurate service delivery, have come to rely heavily on simple tools to aid in reducing human error. An important tool in error management across all of these fields is the checklist, a key instrument in reducing the risk of costly mistakes and improving overall outcomes.
A checklist is typically a list of action items or criteria arranged in a systematic manner, allowing the user to record the presence/absence of the individual items listed to ensure that all are considered or completed. A sound checklist highlights the essential criteria that should be considered in a particular area. Checklists can differ from other cognitive aids or protocols in that they lie somewhere in between an informal cognitive aid, such as a Post-It note or a string around your finger, and a protocol, which typically entails mandatory items for completion to lead the user to a predetermined outcome. Checklists can provide guidance to a user and act as verification (a “check”) after completion of a task, without necessarily leading users to a specific conclusion.
Checklists can have several objectives, including memory recall, standardization and regulation of processes or methodologies, providing a framework for evaluations or as a diagnostic tool [4]. However, regardless of the nature of the checklist, the principal purpose of their implementation is commonly error reduction or best practice adherence. Their efficacy as a cognitive aid likely lies in their ability to use the theories of “category superiority effect” or “chunking” where grouping relational or item-specific information in an organized fashion can help to improve recall performance [5], [6]. List instructions are also often better understood and recalled than information in paragraph format [7].
Of the literature available regarding the use of checklists in industry, the focus lies heavily on aeronautics and aviation, manufacturing quality control, and, to an evolving extent, healthcare. This review will highlight the main areas in which checklists are already used most consistently, their specific contributions to that field, and their transition into the healthcare arena.
Section snippets
Aviation
The majority of literature published to date regarding the use of checklists in the workplace focuses on aviation and aeronautics. Primarily because of the high-risk environment in which pilots and astronauts find themselves, these industries have adapted both paper and electronic checklist as tools to help decrease human error.
This profession has recognized the likelihood of human error to occur under daily work conditions. For this reason, all pilots, from Air Force aviators to recreational
Product manufacturing
In industries such as product manufacturing, where the smallest error in the development or production process can endanger the public and increase manufacturing costs, error management is vital. For fields in which a governing regulatory body monitors the quality of the output, checklists are integral in ensuring the proper operating procedures are followed and the standards of quality are upheld.
Although several processes are highly monitored, including automobile or food manufacturing, the
Healthcare
The Institute of Medicine estimates that medical errors cause between 44 000 and 98 000 deaths annually in the United States alone, resulting in US$17 to 29 billion in costs annually [18]. This same report comments on the delay by the healthcare industry in adopting the same rigorous error management precautions and attention to ensuring basic safety as compared to other high-intensity areas such as aviation. The Institute of Medicine is certainly not the first organization or healthcare provider
Critical care
Checklists have slowly begun to make their way into the field of critical care medicine. Checklists may be particularly relevant to critical care, as the complexity of medical conditions seems to be increased in this environment.
Certain procedures or diagnoses that have been targeted for the use of checklists have shown significant improvements in outcome. After the implementation of a checklist to standardize the withdrawal-of-life-support process in two teaching hospital tertiary care
Conclusion
In industries where the welfare of a human being is at risk, checklists can help to ensure that performance and safety standards are met. Where products are manufactured, landings and takeoffs are required, evaluations are performed, or medical procedures are carried out, evidence indicates that checklists may reduce errors, improve safety, and improve outcomes. As patient safety and performance improvement become a stronger focus of the medical profession, the use of simple tools for error
Acknowledgment
The authors would like to sincerely thank Dr Rob Fowler for his input and guidance in the development of this manuscript.
References (34)
- et al.
Cognitive fatigue and complex decision making under prolonged isolation and confinement
Adv Space Biol Med
(1996) - et al.
Evaluation of simple criteria to predict successful weaning from mechanical ventilation in intensive care patients
Br J Anaesth
(2004) - et al.
Evaluation of a medical equipment checklist before intensive care room opening
Ann Fr Anesth Reanim
(2003) - et al.
Improving communication in the ICU using daily goals
J Crit Care
(2003) - et al.
Error, stress, and teamwork in medicine and aviation: cross sectional surveys
BMJ
(2000) - et al.
Stress and cognition: a cognitive psychological perspective
NASA
(2003) - Scriven M. The logic and methodology of checklists....
- et al.
Relational and item-specific information as determinants of category superiority effects
J Gen Psychol
(1995) Explanations of grouping in immediate ordered recall
Mem Cognit
(1989)- et al.
The influence of list format and category headers on age differences in understanding medication instructions
Exp Aging Res
(1998)
On error management: lessons from aviation
BMJ
Today's electronic checklists reduce likelihood of crew errors and help prevent mishaps
ICAO J
Cited by (462)
Employee work habits: A definition and process model
2024, Human Resource Management ReviewGuide to perioperative checklist design, implementation, and integration
2024, Journal of Clinical AnesthesiaHome infusion services in Saudi Arabia: Where are we standing?
2023, Saudi Pharmaceutical Journal