Failure Modes and Effects Analysis (FMEA) are utilized extensively in our hospitals in an effort to mitigate risk and help create a safer environment for our patients.  As discussed in my last article, the completion of the FMEA is often times a pencil-whipping exercise.

We know that we cannot continue to do the same things and expect different results.  We know about the 1 in 3 patients harmed in our hospitals, or the 400,000 preventable deaths per year.  We need to change.  I propose that we effectively complete the FMEA, as required by our accreditation body, and that we supplement our risk position with checklists.

Checklists are currently in use in our hospitals. Pharmacy uses checklists for certain activities in the pharmacy, such as compounding.  Labs use checklists for processing lab tests.  Dietary uses checklists and so on.  But what is so special about a checklist?

Checklists are created with the intent to achieve a certain objective. Checklists are a basic listing of actions to be completed in clinical or non-clinical settings with the objective that no step will be missed.  These listing of actions in the checklist should be created and agreed upon by a cross-functional group, specifically those that affect or are affected by the process in question.  There must be a lot of science and experience in each checklist. This common theme of process management with risk integration is the basis for improvement and a sustainable patient safety environment.

The majority of errors in healthcare are a result of omission rather than mistakes. As healthcare workers, we typically omit a step in a process rather than completing a step incorrectly.  The discipline presented by the checklist can greatly mitigate the omission of steps. Checklists should now have a more prominent place in healthcare due to their inherent design, a simple basic listing of actions.  Checklists also require maintenance and updating.  Using an outdated checklist may also be detrimental to patient safety.

Implementing a more comprehensive use of checklists requires a willingness of the persons involved to change.  This has been a common theme in previous articles regarding the creation of a patient safety culture.  Implementing an enhanced use of checklists is no different.  Change is now much more common in our healthcare environment than it was just 6-8 years ago.   This fact may not make the task less arduous.  The degree of acceptance among clinicians for this change is directly related to the degree of success.

Checklists have shown significant successes in many industries and professions outside of healthcare, mostly due to the effect on of checklists on human factors.  Again, consider the aviation industry.  Pilots, First Officers, Air-Traffic Controllers all follow a checklist for takeoff and landing activities for each flight, regardless of how many times that activity is performed that day.  The requirement is that each step of these checklists will be completed as intended.  This is also the expectation of the stakeholders, such as passengers, corporate, the FAA, etc.   Failure to complete these expectations can be catastrophic.

Checklists should be a part of a larger plan to create a meaningful patient safety culture.  As with all changes, we create a vision of how our hospitals should function as a safe environment.  We create objectives to strive for to realize our vision.  We create plans to meet our objectives, and then we work the plan.  Along the way, we monitor and measure our plan to ensure effectiveness.  We make necessary corrections to achieve our objectives and continue the cycle.  The outcome will be our vision realized.  Checklists should be a part of the plan to achieve a safer environment for our patients.

Bio: 

Ted Schmidt is a Pharmacist, a Certified Enterprise Risk Manager (CERM©), and a Senior Advisor with BlueSynergy Associates, LLC.  BlueSynergy Associates maximize innovation, experience and customer perspective to reduce risk and make hospitals a safer environment. He currently advises and instructs hospitals in quality, risk, safety and environmental management systems.  Ted led the largest ISO 9001 implementation in healthcare at the Veterans Administration.  He is a Senior Member of the American Society for Quality and a certified Lead Auditor in quality management systems by Exemplar Global.  He can be reached by email at tschmidt@bluesynergyassociates.com. Follow BlueSynergy on LinkedIn (www.linkedin.com/company/bluesynergy-associates-llc) and Twitter (twitter.com/BlueSynergyHlth)