CHECKLISTS SAVE LIVES
Checklists can save you time, money and lives. Just ask Boeing Airlines. Their B-17 prototype crashed simply because the two pilots “forgot” to disengage the Gust Lock. That was in 1935. Both pilots were killed. The prototype was destroyed. Boeing introduced checklists. Nowadays a typical commercial airline pilot would use about six different checklists prior to takeoff. That is usually about 30 different items to inspect, engage, and check off before takeoff. Pilots and crew who have been cavalier about checklists have paid the price.
In 2014, a business jet registered to SK Travel, LLC, and operated by Arizin Ventures LLC, overrun the runway, and collided with approach lights and a communication antenna, killing the crew of three and four passengers. The National Transportation Safety Board found out the following as a result of their investigations as the probable cause of the crash: “During the engine start process, the flight crew neglected to disengage the airplane’s gust lock system, which locks the elevator, ailerons, and rudder while the airplane is parked to protect them against wind gust loads. Further, before initiating takeoff, the pilots neglected to perform a flight control check that would have alerted them of the locked flight controls. A review of data from the airplane’s quick access recorder revealed that the pilots had neglected to perform complete flight control checks before 98% of their previous 175 takeoffs in the airplane, indicating that this oversight was habitual and not an anomaly. Check the number of times the word “neglected” was used in that paragraph alone. In effect, the particular crew was in the habit of disregarding the standard checklists prior to flying. They did this one hundred and seventy-one times without incident on that particular airplane, but when it finally caused a problem, it led to a loss of lives. The interesting fact is that the pilots were not novices. The Captain had flown more than 11, 250 hours. The First Officer had flown more than 18,200 hours of flight time as pilot-in-command and 2,800 hours in Gulfstream-IV airplanes. But despite their vast experience, they were negligent when it came to observing protocols. A team is only as strong as its checklist.
The airline industry uses checklists to ensure that critical things are actually carried out and recorded.
The field of medicine has greatly evolved over the past 200 years, and many aspects of patient treatment have been standardized and automated. Surgery has greatly benefited from standardization and has used it to effectively improve patient outcomes. A simple thing like an instrument count has gone a long way to ensuring that various instruments are not left inside a patient’s abdomen after a procedure. Those hospitals that have ignored the Instrument count have suffered negative outcomes and negative publicity as a result of catastrophic outcomes. The loss of lives and morbidity that have resulted from such incidents are almost innumerable globally.
The fact is that no matter how skilled a team is if they would not pay attention to standardization, they would eventually get into trouble. A team is just as strong as its checklist. The use of a checklist has many benefits.
Firstly a checklist helps us become better organized. It is simpler to do steps 1 to 10 in that order repetitively than to simply attempt to tackle 10 tasks simultaneously.
A checklist actually enhances creativity too, because it becomes easier to master a set of repetitive steps. As we instinctively begin to perform these tasks with mastery, our imagination is free to take on other tasks. Instead of trying to remember what to do next, a checklist takes care of that, and we can use our minds for more creative tasks.
A checklist enhances productivity because it is easier to accelerate the performance of repetitive tasks individually, leading to more efficient use of the time.
It is easier to delegate specific tasks when we use checklists because there is a way to verify that they are accomplished.
Most importantly, checklists are a lifesaver. Since the introduction of checklists, surgical infections have reduced significantly, leading to a significant reduction (more than 40 percent) in mortality from various procedures.
The use of checklists must be embraced by all health practitioners and hospitals, in order to deliver a predictable level of high-quality care to patients.
Checklists should be used even for the most basic of functions. For example, there are clear recommendations that have been put forward when it comes to the components of a general wellness visit for various age groups and based on gender. Using a checklist ensures that it is possible to conduct a more thorough exam every single time, rather than leaving it to the discretion of the practitioner. Of course, where it is necessary, changes can be made that would suit the specific patient. This simplifies the life of both the doctor and the patient. It is simpler to simply check off a list of things to be done than to laboriously try to list them from memory every single time.
It is not enough to have a checklist in place, however. It must be enforced. There is no team of one, which is why the nurse has a duty to cross-check that the items are actually executed according to plan. There is a nurse who stopped a cardiothoracic surgeon after an open heart surgery from closing up. She insisted that an instrument had been left inside the patient’s chest. The surgeon was adamant. He insisted on closing. He was sure he had accounted for all his instruments. The nurse stood her ground and said: “I will not allow you to close.” The surgeon was angry. They did the instrument count again. That instrument was missing. When the doctor removed his initial clips, there was the instrument in the chest of the patient. These incidents have happened time and again. A good team leader knows the value of his team members, and rather than try to shout them down, will instead empower them to make the team more effective.
Using checklists will greatly enhance the work of the Ghanaian doctor. Not only will the doctor become more efficient, but the patients will also be better satisfied. Time will be saved as well. Instead of writing copious notes, simply checking off items that should be done or that have been done will save a lot of time.
Checklists do not get in the way. They actually make the way clearer and simpler for everyone. Would you like your pilot to say to his First Assistant during taxiing “I wonder if the Gust Lock is off or on?” or you’d rather rest knowing that every single item on the checklist had been meticulously checked and cross-checked. A single “sheet of paper” can save you from a lot of trouble. Literally.
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