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Created January 13, 2016 11:10
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Overview of why checklists are great, and how to make good checklists

Why use checklists?

According to Atul Gawande:

The primary aim of a checklist is to prevent human failure, either from ignorance (you don't know what you don't know) or ineptitude (knowledge is applied inconsistently or incorrectly).

The secondary aim of a checklist is to force people to talk to each other and foster teamwork. This is known as "activation phenomenon": giving people a chance to say something at the start of a procedure seems to activate their sense of participation and responsibility and their willingness to speak up.

What makes a good checklist?

  1. Define clear pause point at which the checklist is supposed to be used.
  2. Choose either “DO-CONFIRM” or “READ-DO”:
    • DO-CONFIRM: checks after tasks are done
    • READ-DO: carry out tasks as they are checked off
  3. Checklist cannot be lengthy. Rule of thumb: 5-9 items. Depends on context/situation. After 60-90 seconds checklist becomes a distraction, people begin shortcutting. Focus on "killer items"; the steps most dangerous to skip and most often overlooked. This is the most difficult part of checklists: managing the tension between brevity and effectiveness.
  4. Wording should be simple and exact, familiar to profession
  5. Look matters: fits on one page, free from clutter and unnecessary colors, use upper and lower case for ease of reading, sans serif font.
  6. Test in real world and iterate to improve effectiveness. The goal is not to check boxes. The goal is to embrace a culture of teamwork and discipline.

You may find it useful to look at Gawande's famous WHO surgical checklists.

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