A checklist is a type of job aid used in repetitive tasks to reduce failure by compensating for potential limits of human memory and attention. It helps to ensure consistency and completeness in carrying out a task. A basic example is the "to do list".[1] A more advanced checklist would be a schedule, which lays out tasks to be done according to time of day or other factors. A primary task in checklist is documentation of the task and auditing against the documentation.[2]
Use of a written checklist can reduce any tendency to avoid, omit or neglect important steps in any task.[3]
Checklists have been used in healthcare practice to ensure that clinical practice guidelines are followed. An example is the WHO Surgical Safety Checklist developed for the World Health Organization and found to have a large effect on improving patient safety[6] and subsequently found to have a nil effect in a cohort of hospitals in the Province of Ontario in Canada.[7] According to a meta-analysis after introduction of the checklist mortality dropped by 23% and all complications by 40%, higher-quality studies are required to make the meta-analysis more robust.[8] However, checklist use in healthcare has not always met with success and the transferability between settings has been questioned.[9] In the UK, a study on the implementation of a checklist for provision of medical care to elderly patients admitting to hospital found that the checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices, but that work is needed to understand whether and how checklists can be embedded in complex multidisciplinary care.[10]
A checklist may be used to identify the action, after which it is done, then checked off as complete and the next item identified, known as the Read–Do process, or the tasks may be done, and then the checklist consulted to ensure that nothing has been left out, the Do–Confirm process, in which the status of tasks must be remembered until checked off, which may result in more errors.[5]
Checklists are often presented as lists with small checkboxes down the left hand side of the page. A small tick or checkmark is drawn in the box after the item has been completed.
Other formats are also sometimes used. Aviation checklists generally consist of a system and an action divided by a dashed line, and lack a checkbox as they are often read aloud and are usually intended to be reused.
Ranapurwala et al. (2017) found:[5]
[T]he use of memorized checklists was similar to not using any checklist at all; hence the use of written checklists should be encouraged, instead.
Characteristics of effective checklists include:[12]
The design of a checklist should fit the purpose of the list. If a checklist is perceived as a top-down means to control behaviour by the organisational hierarchy it is more likely to be rejected and fail in its purpose. A checklist perceived as helping the operator to save time and reduce error is likely to be better accepted. This is more likely to happen when the user is involved in the development of the checklist.[5]
Rae et al.(2018) define safety clutter as "the accumulation and persistence of 'safety' work that does not contribute to operational safety", and state that "when 'safety' rules impose a significant and unnecessary burden on the performance of everyday activities, both work and safety suffer".[5]
Excessive dependence of checklists may hinder performance when dealing with a time-critical situation, for example a medical emergency or an in-flight emergency. Checklists should not be used as a replacement for common sense. Intensive training including rote-learning of checklists can help integrate use of checklists with more adaptive and flexible problem solving techniques.[citation needed]
Experimental work has shown that memorised checklists are less effective than written checklists in identifying unsafe conditions when time is not critical.[3]
