I am giving a keynote presentation about reducing medical errors at the annual Health Care Quality Summit of the Saskatchewan Health Quality Council in a couple of weeks and was asked to fill out the usual forms beforehand. In so doing, I inadvertently demonstrated one of the dangers of checklists. As a nurse colleague once said to me, if you create a checklist, people will check it.
Indeed, in the wrong side surgery I have discussed from time to time, the circulating nurse actually checked the portion of the patient record indicating that a pre-surgical time-out had taken place, even though it had not. Why did she do that? Well, she had left the OR briefly, and when she came back the procedure had started. Therefore, she assumed that the time-out had taken place and checked off the box in the patient record to document the "fact." (The new protocol makes that not possible: The nurse has to witness the time-out.)
In short, unless there is a thoughtful work process underlying a checklist, it can still permit failure.
In my case, no harm was done. My host gently wrote:
I was just reviewing the contract that you signed and noticed you checked both boxes (as included in the image below). Could you clarify which one you are consenting to? Can we video record you to make parts of your presentation available online? You are keeping us on our toes!