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I think a key element of checklists, and checklist discipline, is coordination between members of a team. What checklists allow you to do is have accountability across differences in experience/authority/expertise and also track a process over time. In my work as a naval aviator (caveat, I'm still a student), we use checklists in the cockpit to coordinate all sorts of functions such as engine start, takeoff, landing and emergencies. These ensure that we start the engine the same way, verify we are ready for landing, and also handle emergency procedures in an approved way. When there are rank and experience differences in the cockpit these checklists help equalize the disparity, and let less experienced or junior members hold senior members accountable. Before each flight we also follow a briefing checklist, and that includes human factors such as any possible issues relating to illness/medication/stress/alcohol/fatigue/eating. Doing so ensures that there is always a place for people to vocalize anything that the team should know. Previously I worked on a Coast Guard cutter, and we used similar checklists to ensure we were prepared to get underway, enter port, or complete a complex evolution like tow another vessel. For these checklists the main value was in verifying between multiple changes of team personnel that everything was being completed to meet the timeline. The checklist served as documentation that the person before you had collected the necessary information, made proper notifications, and started/finished processes. It has baffled me when I hear that medical personnel dont use checklists for these exact reasons. They perform time critical, high stress procedures that have a fairly documented set of steps. They require a team of personnel that have different scopes of expertise, experience, and authority. There are frequently changes in the team's composition over the duration of the patients care, and it seems like the patient will be handed off between different teams that specialize in their own respective areas of patient care. For us in the military it is pretty easy for authority to mandate we use checklists, and the buy in come from accident investigations revealing that checklists were ignored or skipped. Is there an equivalent medical authority that can pass this information down, or does this have to emerge independently from each hospital system? |