Getting Value out of Checklists for Quality Improvement

Pre Trip Checklist By Oregon Department of Transportation, via Wikimedia Commons
Pre Trip Checklist via Wikimedia Commons

Just finished reading the excellent article, Amazing Checklists by Ian Whittingham, PMP over at Ian gives a brief history of checklists used in business and then tracing them back to early checklists found in the palace of King Minos at Knossos for regulating the palace’s administrative processes. Ian then brings us a great case study about using checklists for patient care in Intensive Care Unit (ICU) patients, patient safety and prevention of secondary infection prevention due to use of catheters. The Keystone Initiative, the results which were published in the New England Journal of Medicine, showed that the use of checklists saved an estimated 1,500 lives and approximately $175 million in costs in the first 18 months of operation. Amazing results when you consider that we are talking about saving lives, not delivery of products.

I’ve seen both the PM and SQA value of checklists, but the when I started into Health Informatics the value went off the scale in terms of patient safety and risk mitigation.

What I’m curious about is how many organizations adopt the “right kind” of checklist that really reinforces quality control instead of just being quality assurance focused. This is of particular interest in non-manufacturing industries. It seems to me that there should be a blend between checklists for quality control and quality assurance. The reason for needing a blend is due to the very real danger of creating a bureaucracy created to compensate for incompetence and lack of discipline. It’s when checklists are designed to reinforce the art and science of the crafts within each industry that I see the biggest improvements of quality and process adherence.

So there are several “smells like” tests that I’ve run across that could be used by business leaders to determine where on the spectrum of process adherence focus vs. value delivery focus your checklists are.

The organization is likely creating a bureaucracy if any of the “smells like” tests are true:

  • Checklists call out the structure of process supporting documentation instead of the quality of the content of process supporting documentation
  • Checklists are being used and there is no understanding of the purpose of the checklist by the checklist user (e.g. just checking the box because that is what will get the product or service delivered).

The organization is likely using checklists correctly if any of the “smells like” tests are true:

  • Checklists call out that the work product has met the threshold of the definition of being a quality product and has met the acceptance criteria created by the user of the product
  • Checklists are being used to prevent risk of major defects or errors when implementing the product or service (e.g. Process steps were followed).

The latter should be used judiciously. A good rule of them is to determine if using the checklist causes more that a 0-3% in efficiency.

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Post Disclaimer

The information contained on this post is my opinion, and mine alone (with the occasional voice of friend). It does not represent the opinions of any clients or employers.