Checklists for Quality Improvement and Evaluation in Behavioral Health

Abstract

I have a small, tattered notebook in which I keep a running list of tasks I need to do in order to keep my professional and personal life on track. My colleagues are so familiar with this notebook and how much I depend on it day to day that if I commit to do something, they’ll prompt me to record it in my notebook. They know I’m serious about a task when it goes on the list. I keep my notebook handy at all times. That way, when I think of something I need to do, I can quickly translate it from fleeting thought to words on paper, thereby immediately reducing my cognitive load: I know I can refer to my checklist later, so I do not need to expend effort to maintain the thought in my accessible memory. I’ve canvassed my colleagues and most have their own strategies for recording and tracking the things they need to do. Some prefer to schedule their tasks on a calendar, some use Web-based systems, while others rely on a constellation of post-it notes around their computer monitors. Underlying all these strategies is a recognition that we humans are not that good at holding in our brains all the things we need to do in order to meet our personal and professional obligations. We need tools to help us remember. The “simple” checklist is a common solution. But checklists are powerful tools with potential to do much more than help individuals remember what they need to do on a daily basis.

We need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy—though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies.

It is a checklist.

—Atul Gawande, The Checklist Manifesto

I thank Arlen Gullickson, Goldie MacDonald, and Emma Perk for their review and feedback on a draft version of this chapter.