The Humble Checklist and its Use in Domiciliary Care

This blog post was published for www.Fastroi.com and is reproduced with permssion

The aviation industry is what is known as a high stakes profession and there are very meticulous practices in place in the unlikely event of an air crash taking place. It is now the safest form of transport with the odds of dying in a crash being something like 1 in 29.4million. But it wasn’t always like this. Back in the 1930’s the US Government wanted a new, long range bomber. The Boeing company came up with a new plane with 4 engines, something that set it apart from the competition which were still only using single or twin engined planes. It could fly faster, higher, longer and carry more payload, so the Army were very interested.

Major Pete Hill was the chief test pilot of the US Army Air Corps and he had the responsibility of testing the plane. As Major Hill took off, he must have realised something was wrong quite quickly. He wasn’t able to level off the plane and it kept on climbing until it quickly stalled and fell back to Earth killing all on board. Boeing carried out a meticulous investigation into the crash and they found that the plane had no mechanical faults but that the pilot had forgotten to unlock the elevator control flaps. This meant that they were locked in place making it impossible to level off the plane after take off. In response to this, Boeing created something that would change the airline industry. It wasn’t more training or more technology that was needed. After all, Major Hill was one of the most experienced and well trained pilots of the day. The problem was that the pilots had become overwhelmed by the complexity of what they were doing. Simply put, humans are fallible and prone to forgetting things. So in order to resolve this Boeing created the ‘Before Flight Checklist’ and it led to such a significant improvement in aircraft safety.

This story was told by Dr. Atul Gawande in his book ‘The Checklist Manifesto’. Dr. Gawande developed a Surgical Safety Checklist in 6 hospitals around the world ranging from the UK, Tanzania, Canada and the Philippines. The results were impressive. Postoperative complications and death rates both rates fell by 36 percent on average. Dr. Gawande realised that the levels of complexity that had developed in medicine meant that there was more specialisation. This meant that there was more team activity for every case than in the 1930’s, when a single Doctor would manage the treatment with the support of a small nursing team.

So with a well written checklist, we can see that significant improvements can be achieved not only in the way individuals work but also in teams. With Fastroi’s Real-Time Care™ we were able to implement checklists into the domiciliary and residential care system – While we call them task lists in RTC, they are essentially checklists for the care workers to ensure that nothing is forgotten. We understand the power that taking the pressure off of care workers and placing it within the tools and processes can have on staff. As with any activity, if we record it, then we can prove that it happened. Having this kind of checklist built into Care Management Software, we are able to provide the care staff the reassurance that everything they need to do during a visit will be presented to them in the form of a task list which can be customised for every visit. As every task is confirmed as ‘done’, it is saved on to the server so that an electronic record of the visit exists which can then be used to evidence what was done during the visit.

Where an electronic task list can be superior to a paper based one is in the level of information and detail that can be incorporated. We can add information about the clients needs, wants and requirements so that it becomes truly person centred. The checklist has changed the lives of millions of people from aircraft passengers to patients in operating rooms and their families. The beauty of the checklist is that it also benefits the airlines and the engineers who prepare the planes and the surgeons, nurses and other OR staff who no longer have to worry about forgetting a critical activity brought about by unmanageable complexity.

By skilfully designing the checklists into the tools that are being used for reporting, recording and planning we can reduce the chances of mistakes being made due to staff being under pressure. Less mistakes means greater quality, greater quality means better care.