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How a Checklist can Boost Efficiency and Reduce Mistakes

Learn how The Checklist Manifesto can be incorporated into your industry and learn how a simple checklist can reduce mistakes, increase productivity, and keep revenue flowing properly.

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How a Checklist can Boost Efficiency and Reduce Mistakes

  1. 1. Checklist Manifesto How a checklist can boost efficiency and reduce mistakes
  2. 2. Atul Gawande American surgeon, writer, and public health researcher. Practices general and endocrine surgery in Massachusetts. Author of The Checklist Manifesto, Being Mortal, Complications, and Better. Source: https://en.wikipedia.org/wiki/Atul_Gawande
  3. 3. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.” - Atul Gawande
  4. 4. Two Reasons of Failure 1. Ignorance- Science has given us only a partial understanding of the world and how it works 2. Ineptitude- Knowledge exists yet we fail to apply it correctly
  5. 5. Examples in Healthcare • Ignorance- In the 1950’s, heart patients were put on bed rest for weeks in order to avoid strain to heart • Ineptitude- In 2006, only 50% of hospitals achieved proper testing for heart attack patients undergoing cardiac balloon therapy that needed completion within 90 minutes after arriving at hospital
  6. 6. Checklists can fill the gap between error and success rate
  7. 7. “The checklist cannot be lengthy. Keep it between five and nine items, which is the limit of working memory.” - Atul Gawande
  8. 8. PATIENT HAS CONFIRMED • IDENTITY • SITE • PROCEDURE • CONSENT SITE MARKED/NOT APPLICABLE ANAESTHESIA SAFETY CHECK COMPLETED PULSE OXIMETER ON PATIENT AND FUNCTIONING DOES PATIENT HAVE A: KNOWN ALLERGY? NO YES DIFFICULT AIRWAY/ASPIRATION RISK? NO YES, AND EQUIPMENT/ASSISTANCE AVAILABLE RISK OF >500ML BLOOD LOSS (7ML/KG IN CHILDREN)? NO YES, AND ADEQUATE INTRAVENOUS ACCESS AND FLUIDS PLANNED NURSE VERBALLY CONFIRMS WITH THE TEAM: THE NAME OF THE PROCEDURE RECORDED THAT INSTRUMENT, SPONGE AND NEEDLE COUNTS ARE CORRECT (OR NOT APPLICABLE) HOW THE SPECIMEN IS LABELLED (INCLUDING PATIENT NAME) WHETHER THERE ARE ANY EQUIPMENT PROBLEMS TO BE ADDRESSED SURGEON, ANAESTHESIA PROFESSIONAL AND NURSE REVIEW THE KEY CONCERNS FOR RECOVERY AND MANAGEMENT OF THIS PATIENT SIGN IN CONFIRM ALL TEAM MEMBERS HAVE INTRODUCED THEMSELVES BY NAME AND ROLE SURGEON, ANAESTHESIA PROFESSIONAL AND NURSE VERBALLY CONFIRM • PATIENT • SITE • PROCEDURE ANTICIPATED CRITICAL EVENTS SURGEON REVIEWS: WHAT ARE THE CRITICAL OR UNEXPECTED STEPS, OPERATIVE DURATION, ANTICIPATED BLOOD LOSS? ANAESTHESIA TEAM REVIEWS: ARE THERE ANY PATIENT-SPECIFIC CONCERNS? NURSING TEAM REVIEWS: HAS STERILITY (INCLUDING INDICATOR RESULTS) BEEN CONFIRMED? ARE THERE EQUIPMENT ISSUES OR ANY CONCERNS? HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN WITHIN THE LAST 60 MINUTES? YES NOT APPLICABLE TIME OUT SIGN OUT Before induction of anaesthesia Before skin incision Before patient leaves operating room SURGICAL SAFETY CHECKLIST (FIRST EDITION) Atul Gawande’s Surgical Checklist used to reduce morbidity and mortality in the Global population
  9. 9. “Good checklists are precise. They are efficient, to the point, and easy to use even in the most difficult situations.Good checklists are, above all, practical.” - Atul Gawande
  10. 10. Benefits of Checklists üEnsures consistency üUsed to reduce failure üAids in memory and üInformational aid üCompleteness when attention carrying out a task
  11. 11. How Healthcare Checklists have Improved
  12. 12. https://www.goodreads.com/author/quotes/3078.Atul_Gawande?page=5 5-Point checklist reduced line infections from 10% to 0
  13. 13. “One essential characteristic of modern life is that we all depend on systems—on assemblages of people or technologies or both—and among our most profound difficulties is making them work.” - Atul Gawande
  14. 14. In the Workplace… üEmployees feel accountable for performing inspections because there is a written record üWorkers feel organized when provided guidelines on inspections
  15. 15. “Just ticking boxes is not the ultimate goal. Embracing a culture of teamwork and discipline is.” -Atul Gawande
  16. 16. Source: https://inspectioneering.com/content/2016- 05-23/5360/instilling-a-checklist-culture-to-improve-- asset-integrity-manag Facility Checklist Benefits Process Reliability- Tasks completed correctly the first time decreasing re-work Verifiable Compliance-Target specific steps of a process for improvement increasing worker accountability and quality assurance Operational Insight- Discover asset data to identify and correct non-productive time and improve on cost Best Practice Capture- Identify what’s working in facility and replicate increasing production efficiencies
  17. 17. Could Your Industry Benefit from a Checklist?
  18. 18. “We know the patterns.We see the costs. It’s time to try something else. Try a checklist.” - Atul Gawande

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