Joanne Palmer: An argument for the basic, everyday checklist
January 12, 2011
Steamboat Springs — Turn off coffee pot. Check. Print out boarding pass. Check.
Return library books. Check. Check. Check.
I am now a fan of checklists.
Here's how it happened. I went to the store five (count 'em, five) times to buy a new toothbrush for my pearly whites. I left the store five (count 'em, five) times without the toothbrush. I came home with potatoes and eye drops and dishwashing soap and a couple of boxes of cereal and crackers. But no toothbrush. Along about 9 p.m. I'd go upstairs to brush my teeth and bonk myself on the head.
Forgot the toothbrush.
Insanity is doing the same thing twice and expecting a different result. So after five times of not remembering, I wrote "buy toothbrush" on a piece of paper and voilà … I remembered.
Then my inner librarian got involved. Whatever the topic, there's always a book. The one I found, recommended by my sister, is worth a read: "The Checklist Manifesto," by Atul Gawande. Gawande is a laid-back kind of guy — not an overachiever type at all. Just a surgeon in Boston, a staff writer for The New Yorker, an associate professor at Harvard Medical School, the father of three kiddos and a few other important things. His book makes a compelling case for checklists, particularly in medical situations.
Early on, the book cites the following keep-you-up-at-night statistics: "studies have found that at least 30 percent of patients with stroke receive incomplete or inappropriate care from their doctors, as do 45 percent of patients with asthma and 60 percent of patients with pneumonia. Getting the steps right is proving brutally hard, even if you know them."
Last year, when my mother was hospitalized, the staff gave her medicine she was allergic to three times. Not once. Not twice. Three times. The orders to not give her these drugs were in her chart. Repeatedly, I had talked about drugs to not administer with her doctors, nurses, anyone who would listen. And yet, one fateful morning I arrived and found her picking at her sheets, seeing imaginary friends, and talking nonsense — all indicators that she had been given the wrong drug. Again. I blew up. I was red hot. And in my anger, I did something that inadvertently may have helped or been part of the solution. I stormed out of her room, grabbed five sheets of paper and a large magic marker. I made signs. Big signs. "Do not administer these drugs." I listed the drugs and then I decorated her room with them. I taped them to the door to her room, above her bed, by the clock, anywhere and everywhere the medical staff might see them. They never gave the wrong drugs again.
Checklists aren't sexy. They are decidedly low-tech. I think I am smarter than a mundane little checklist. I tell myself daily, "I'll remember. I can keep it in my head." And yet, I get to the grocery store without the grocery list, leave the house without my cell phone or the check I urgently needed to deposit. Gawande argues that checklists "get the dumb stuff out of the way, the routines your brain shouldn't have to occupy itself with (Did the patient get her antibiotics on time?) and lets it rise above to focus on the hard stuff."
Checklists don't have to be long. Gawande's surgical safety checklist is divided into three sections with fewer than 20 questions. In case of engine failure, a US Airways checklist has only six key steps. Step one: Fly the airplane. Every yoga class I attend reminds students repeatedly to breathe.
Breathe. Fly the plane. Try a checklist. Buy a new pen and create one. Then think back to December and Mr. Claus, who undoubtedly is a checklist fan. He not only makes a list, but checks it twice.