The Humble Checklist

In complex fields, many serious errors come not from ignorance but from ineptitude, that is, failing to apply what is already known. A surgeon may know perfectly well that the patient's identity and the correct site of the operation should be confirmed, yet under pressure a step is skipped. Simple checklists, borrowed from aviation, have been introduced in many hospitals to guard against such lapses. A short list read aloud before an operation, confirming the patient, the procedure, allergies, and the availability of blood, takes only minutes, and studies in several countries reported fewer complications and deaths after checklists were adopted. The idea met resistance at first. Experienced professionals often felt that a checklist insulted their expertise, as if they were being treated like beginners. Advocates answered that the checklist is not a substitute for skill but a support for it: it handles the routine, easily forgotten steps so that attention is free for the genuinely difficult judgments. They also noted a less obvious benefit. Requiring every member of the team to introduce themselves and speak before the operation makes it easier for a junior nurse to raise a concern later, a small change in culture that can matter as much as any item on the list.