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The Critical Checklist

The Critical Checklist

Our roles in Student Boarding are not as knife-edge as responding to an aircraft malfunction at 30,00 feet or trying to save a life on the operating table. However, there are situations in Boarding where a student could be harmed or even die if correct procedures are not followed.

These include:
• Student anaphylaxis reaction
• Administration of medication
• Emergency responses e.g. fire evacuation, or an armed intruder lockdown
• A missing student
• A risk of suicide or self-harm

The answer to responding to complex situations correctly is the simple idea of The Checklist.

All these situations can have a carefully thought-out checklist that a trained person can easily follow and implement, that will help avoid mistakes and omissions. Checklists protect against failure because they remind us of the minimum steps required, even in very complex tasks.

Other procedures in boarding could also benefit from checklists:
• Student (and parent) induction
• Staff induction
• Workplace health and safety risk assessments
• Annual maintenance schedules
• Excursion / outing procedure

Surgeon Atul Gawande wrote ‘The Checklist Manifesto’ in response to a conundrum he noted in the field of medicine. Increasing knowledge, specialisation and complex procedures allowed doctors and nurses to treat medical issues and save lives as never before. However, very competent, and knowledgeable doctors were missing vital steps or making mistakes that harmed or even killed patients. He concluded that the volume and complexity of knowledge has exceeded any one’s ability to deliver their service consistently, correctly, and safely.

His examples:
• The average ICU patient requires on average 178 actions or procedures a day and the possibility or missing a procedure or making a mistake can have serious consequences.
• Half of all American deaths during surgery (75,000) were caused by preventable human error.
• This is also the case in other fields such as complex construction projects, advanced technology, responding to aviation incidents and predicting weather events.

Gawande’s steps for Developing an Effective Checklist
1. Define a clear pause point or stop in the workflow where the checklist is to be used.
2. Decide if the checklist is to be:
a. Do and then confirm checklist (do first and confirm after pausing to check that every step has been completed)
b. Read and then do checklist (do the task in a step-by-step process following the instructions of the checklist)
3. Keep checklist short – only 5 – 9 items and never more than a page. (Should take less than 60 seconds).
4. Keep the wording simple and precise – language familiar to the user
5. Focus on the most important items that will be most dangerous if missed.
6. Make sure the order of items is correct.
7. Test the checklist in real situation and make changes as required
8. Collect data on the checklists (are they being used, how often and has it resulted in any changes)

Please share your checklists so we can learn from each other, as we keep optimising our student care in boarding,

Steve & Jenny Florisson
March 2022

The Book;
The Checklist Manifesto. How to get things right. Atul Gawande

YouTube Videos
https://www.microsoft.com/en-us/research/video/the-checklist-manifesto/
https://www.youtube.com/watch?v=bCDmDzIOZ-g
https://www.youtube.com/watch?v=18ns58FyPmY

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