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Implementing Checklists - Part 3

Checklists and systematized processes help make sure that we don’t forget simple things which may improve patient outcome. Any clinic can benefit from using them. Just HAVING a checklist, though, is not enough. You have to put it into practice and make sure it works in your clinic setting. You also need to make sure people actually use it. Often, implementing checklists encounters resistance from some in a clinic who think it’s a waste of time, it wouldn’t help them (with the implication being that they are “above” needing such things), or it would decrease efficiency.

Once you’ve made your checklist, how do you put it into practice?

Hopefully, during the checklist creation process, you involved others and got buy-in from them. If the practice owner, other veterinarians, and staff were not involved, it is unlikely to be successful. You want to make sure everyone: 1) believes there is a problem, 2) agrees about what the problem is, 3) agrees that a solution exists. You don’t need everyone to agree on WHAT the solution is, although that is ideal. But if people don’t think a problem exists, you won’t get anywhere with the checklist.

Once you have buy-in and have created your checklist, it’s time to deploy it. I suggest having an all-clinic meeting. Remind people of the problem(s) you are trying to manage. Call out specific individuals who either suggested problems or solutions. Remind people that pilots use checklists- the “Miracle on the Hudson” was due primarily to pilots Sullenberger and Skiles following their checklists, rather than their amazing piloting skills. Next, be detailed about what the deployment will entail. When will it start, who will be responsible, what is involved.

Now you have your meeting, and hopefully everyone is on board. Nonetheless, successful implementation requires at least one champion. Once the checklist is active, regularly check in with people to make sure they are using it. Do they have any problems or questions? Is there any pushback? If so, you will need to meet individually with those who are objecting to its use.

The second-most-important piece of implementation (behind getting buy-in) is follow-up. Monitor the results of using the checklist. Continue to ask for feedback. Do a 3-month-post-implementation review. What does everyone like? What can be improved? Show them data which demonstrates how much the checklist has helped. Share stories of staff having helped a patient because of the presence of the checklist.

Improving patient care and safety is not a one-and-done process. It is continual, requiring someone to champion patience safety. Once you have a checklist and implement it, don’t stop. Keep meeting, discussing, and identifying ways to improve patient safety.

Erik Hofmeister DVM Diplomate ACVAA & ECVAA MA MS

Professor of Veterinary Anesthesia

Auburn University

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