By Sean Power, Community Manager, Physician-Patient Alliance for Health & Safety
August 18, 2015
In a recent article, Emily Anthes, writing for Nature, pondered, “Hospital checklists are meant to save lives—so why do they often fail?”
The article outlines some socio-cultural answers: poor implementation, improper and incomplete use, cultural resistance, and lack of buy-in. Technical reasons included that the checklist was poorly worded, time-consuming, or inappropriate for certain procedures.
Contained within Ms. Anthes’ article are four keys that we wanted to highlight for hospitals looking to improve the efficacy of safety checklists.
1. Find a leader who will champion the checklist’s use.
Professor Mary Dixon-Woods, a medical sociologist at the University of Leicester, UK, identified one intensive care unit with “exemplary results”—a high infection rate fell to zero after the checklist program began.
A “charismatic physician who championed the checklist and rallied others around it” played a central role in the checklist’s success.
According to Professor Dixon-Woods:
“He [the physician] formed coalitions with his colleagues so everyone was singing the same tune, and they just committed as a whole unit to getting this problem under control.”
Identifying a leader among practitioners can have a drastic impact on the success of the initiative.
2. Revise the checklist with input from practitioners before deploying it.
Dr. Nick Sevdalis, implementation scientist at King’s College London, investigated why checklists were not being used properly and found that staff took issue with the checklist because “it was poorly worded, time-consuming, inappropriate for certain procedures or redundant with other safety checks.”
With input from practitioners before deployment, these problems could be avoided and could increase proper use of the checklist.
3. Localize the safety checklist to adapt to your hospital’s culture and workflow.
In the Keystone ICU project, launched in Michigan in October 2003 in which the rate of catheter-related bloodstream infections fell by 66 percent, Dr. Peter Pronovost encouraged the participating ICUs to localize the checklist.
According to Dr. Pronovost:
“They were 95 percent the same, but that 5 percent made it work for them. Every one of these hospitals thought that theirs was the best.”
Localizing safety checklists can also streamline logistics, which can increase participation.
As Ms. Anthes writes:
“When Pronovost was first developing his checklist at Johns Hopkins, he noticed that ICU doctors had to go to eight different places to collect all the supplies they needed to perform a sterile central-line insertion. As part of the Keystone programme, hospitals assembled carts that contained all the necessary supplies.”
By localizing safety checklists, hospitals can ensure it makes work easier for practitioners instead of introducing, as Professor Dixon-Woods described it, “Yet another example of these top-down, intrusive, imposed initiatives”.
4. Gain buy-in by explaining the checklist’s purpose and why it should be used.
Of five hospitals in Washington State participating in a 2011 study, Dr. Atul Gawande and his colleagues discovered that it is crucial for leaders to explain how and why safety checklists should be used.
According to Sara Singer, health-policy researcher at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts:
“That might have included pulling on somebody’s heart strings, it might have included sharing as much evidence as possible, it might have included talking through the theoretical story or giving some important example.”
Hospital leaders need to get buy-in from practitioners in order for checklists to be used properly.
Following these four keys when introducing patient safety checklists at your hospital could help improve checklist efficacy. When patient lives are at stake, it is prudent to take appropriate steps to unlock the full potential of patient safety checklists.
What other pieces of advice would you offer hospital leaders looking to improve safety checklist efficacy at their institutions?