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Where Are The Check Sheets?

Posted April 20, 2011 10:20 AM by geanorm

Editor's Note: CR4 would like to thank Ed Eisermann of GEA Consulting for contributing this blog entry.

Question: "Why do we each use informal check sheets (list) in our daily personal lives, but seldom see them used in business? I recently heard a news piece that about a study that reported that a check list to confirm the critical activities related to surgical procedure are used in only 30 percent of domestic hospitals. So I went to the internet and found the following report. It is very interesting.

http://www.time.com/time/health/article/0,8599,1871759,00.html

The above internet sight discusses a study that showed a dramatic reduction in deaths after implementing a surgical check sheet. Next time you or a family member sees a doctor for surgery, you may want to ask the question; "does this hospital have a surgery check sheet?".

Check sheets are a simple tool to ensure that necessary actions are taken, preventing an error or the need for rework. Two simple examples in our daily family lives is the grocery list (a simple reminder of the items we need) to reduce the chances that we need to make a second trip back to the store. Another check sheet frequently found on the refrigerator is the common "To do List".

What we do not see are check sheets in the work place for people doing repeated jobs daily. Yes, office employees use a daily work planner or scheduler, but few of us have check sheets for our repeating tasks.

I once handled a request from a client to study their order process with an ultimate goal of reducing the cycle time from contract signing to scheduling. I found that the number one problem creating delays was data needed by the internal customer from their internal suppliers was wrong, missing or incomplete. This required having the Applications Engineer call the field sales person or customer to confirm the correct data delaying the design work or the component procurement process. Simple check sheets were created based on the most common errors at each stage of the internal process from Application Engineering to Scheduling. The result was far fewer instances of missed information, smoother processing and on time scheduling to meet the commitment date.

Pick any process where instructional data is found to be missing or wrong and create a check sheet. I am confident that use of the "check sheet" technique will increase for a better overall result. Further, it is a great tool when someone is required to fill in while an employee is out of the office or a new employee is added.

- Ed Eisermann

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#1

Re: Where Are The Check Sheets?

04/21/2011 12:17 AM

Very interesting but not surprising.

A related question could be, "why do pilots regularly use check lists as part of flying, while many surgeons do not as part of an operation, when both professions involve complex procedures and where errors can cause death?".

I don't know the answer, but would suggest that surgeons/doctors often not using check lists derives from historical practice, and the fact of some variability in the totality of the majority of surgical operations making the importance of a check sheet less obvious.

My own experience as an engineer engaged with the medical profession (about two decades ago) includes two experiences that highlight the different view of the world that at least some in the medical profession have.

In the first case I expressed amazement that anaesthetic machines were designed in such a way that they could easily be connected up incorrectly. The doctors view was that medical professionalism was enough to avoid error, when as an engineer I knew that many engineered systems were built in a way to minimise connection errors. Later studies showed that the issue I'd raised was important and I believe that some progress has now been made to address this issue.

The second case was with a group of doctors who regularly considered problem devices on a one by one basis. I suggested that it would be better to treat each device as member of a class of devices in the first instance and then to refine the decision implied out of this if necessary. This suggestion was aimed at reducing the work in making the initial decision and in making the consistency of decisions more transparent. While I did win the day on this "obvious" approach, it was not an approach that those (in our group) in the medical profession saw as obvious.

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#2

Re: Where Are The Check Sheets?

04/21/2011 7:47 AM

I suppose it depends on what business you are in!

I am a Chemical Process Engineer of 20 yrs. Two fundamental drawings that we produce are process Flow Diagrams and Piping & Instrument Diagrams from which all the detailesd work is done by Instruments Mechanical etc.

The checklist for both these documents runs to about three excel pages. Most of it is second nature but there are occaisional wrinkles and foibles for each job, but I find it a very useful exercise to do as it helps you step away from the work and see the wood for the trees. They can also be used as part of the development work. ie just look at the checklist to see if you have done everything that is expected to be on the drawing. (Not everything on the list applies to every drawing) so its an aid to the work too.

The checklists have to be filled in (a tick list) and signed by the two engineers signing the drawings off as check and approve and the check list is part of our auditable QA procedure and then has to be filed.

Of course its not infallible as you can get in the habit of skimming down the checklist going yes to everything but I usually find something either missing or needing clarification even if it has to be placed on hold for that issue.

I work in the design of large scale oil/gas currently a grass roots LNG production facility

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#3

Re: Where Are The Check Sheets?

04/23/2011 5:46 PM

Have you read Atul Gawande's book on the subject?

CHECKLISTMANIFESTO

here is link to a pdf intro:

http://the-security-institute.org/userfiles/file/Training%20Page%20PDF/The%20checklist%20manifesto.pdf

Topical post.

Milo

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#4

Re: Where Are The Check Sheets?

06/26/2011 4:06 PM

I also read recently in a book (pg 30, para 2) that at times when hospitals went on strike (except for emergency services) that there was a significant decrease in fatalities. (18% LA, 37% Bogata, and 50% Israel)

makes you tink

Chris

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