Implementation of checklists in health care; learning from high-reliability organisations

A qualitative study based on key informant interviews and field visits followed by a Delphi approach. Eight informants, each with 10-30 years of checklist experience, were recruited from six different HROs.The interviews generated 84 assertions and recommendations for checklist implementation. To achieve checklist acceptance and compliance, there must be a predefined need for which a checklist is considered a well suited solution. The end-users ("sharp-end") are the key stakeholders throughout the development and implementation process. Proximity and ownership must be assured through a thorough and wise process. All informants underlined the importance of short, self-developed, and operationally-suited checklists. Simulation is a valuable and widely used method for training, revision, and validation.Checklists have been a cornerstone of safety management in HROs for nearly a century, and are becoming increasingly popular in medicine. Acceptance and compliance are crucial for checklist implementation in health care. Experiences from HROs may provide valuable input to checklist implementation in healthcare.It has been said that while medicine used to be inefficient, simple, and safe it is now effective, highly complex, and dangerous [1]. Adverse events are documented to affect more than one in 25 hospital patients [2]. Failure to check equipment and lack of vigilance are examples of factors associated with adverse events [3,4]. Realising how prone we as humans are for short term memory loss, it is striking how many potentially dangerous medical procedures are based on perfect memory [5]. In this context, it is rather strange that checklists are not used more often in medicine.Checklists are common in some medical fields, and can be an effective tool to improve care processes and reduce mortality and morbidity [6-11]. Checklists are also shown to be a useful tool in pre-hospital and emergency medicine [12,13]. However, the development and implementation of medical chec