Tag Archives: checklist

Checklists in Software Development

Verify your work with checklists

WHO has recently shown that surgical deaths can be reduced by a third when hospitals follow their Surgical Safety Checklist. The checklist is very low tech. It includes questions like whether the patient has been properly identified, whether the proper tools are available, and whether everyone knows what kind of procedure is about to be done.

If a checklist so simple can save so many lives, I thought the technique could surely help us do better as well. So after reading about this study and their checklist, I’ve been pushing us to create checklists for all the common procedures at 37signals.

We now have checklists in Backpack for confirming that a feature is complete, we have a checklist for preparing the feature for deployment and for executing the deployment, and finally for verifying that the feature is working as expected in the wild.

It’s the kind of stuff that we all know, but that we’ll often forget if we’re not being reminded about it in the moment. Thinking back to the mistakes we’ve made in the past, there are plenty of those that could have been avoided or caught much earlier if we had been using checklists.

This is a great reminder of two things: using checklists and adopting good ideas. Checklists are a simple and effective quality management tool. We use them for our software development (I have been a bit slow at getting them in place but we have been making progress recently). Also this shows how management improvement should work. You get good ideas from others and adapt them for use in your systems. Copying what others do, doesn’t work well. But understanding the concepts they use to improve performance and then adapting those concepts to your organization is the path to improved performance.

Related: Checklists Save LivesFind Joy and Success in BusinessLean, Toyota and Deming for Software DevelopmentThe Power of a ChecklistMost Meetings are Muda

Checklists Save Lives

photo of surgery room

Checklists are a simple quality tool that have been used widely for decades. Pilots use them, without fail, to save lives. Some surgeons have been using them and the evidence is mounting that checklists can save many more lives if more in health care use them. Studies Show Surgeons Could Save Lives, $20B by Using Checklists

Eight hospitals reduced the number of deaths from surgery by more than 40% by using a checklist that helps doctors and nurses avoid errors, according to a report released online today in the New England Journal of Medicine.

If all hospitals used the same checklist, they could save tens of thousands of lives and $20 billion in medical costs each year, says author Atul Gawande, a surgeon and associate professor at the Harvard School of Public Health.

In his study, which was funded by the World Health Organization, hospitals reduced their rate of death after surgery from 1.5% to 0.8%. They also trimmed the number of complications from 11% to 7%.

The study shows that an operation’s success depends far more on teamwork and clear communication than the brilliance of individual doctors, says co-author Alex Haynes, also of Harvard. And that’s good news, he says, because it means hospitals everywhere can improve.

Researchers modeled the checklist, which takes only two minutes to go through, after ones used by the aviation industry, which has dramatically reduced the number of crashes in recent years.

This is more great evidence of the value of applying simple management tools that are already well known. The idea that improvement takes brand new breakthrough ideas is just plain wrong.

Related: Using Books to Ignite ImprovementThe Power of a ChecklistNew, Different, BetterManagement Improvement History and Health CareOpen Source Management TermsFast Company Interview with Jeff Immelt

The Power of a Checklist

Great article on The Checklist – If something so simple can transform intensive care, what else can it do? by Atul Gawande

A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions—but that still amounted to an average of two errors a day with every patient.

In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert. With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much. In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Teams also complained to the hospital officials that the checklist required that patients be fully covered with a sterile drape when lines were being put in, but full-size barrier drapes were often unavailable. So the officials made sure that the drapes were stocked. Then they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it.

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