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Managing Improvement in Healthcare pp 135–154Cite as

Palgrave Macmillan

Checklist as Hub: How Medical Checklists Connect Professional Routines

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Part of the book series: Organizational Behaviour in Health Care ((OBHC))

Abstract

Checklists were introduced in the medical domain as simple procedural interventions that enhance patient safety. However, these checklists are often not translated into actual work routines. To better understand why checklists become routines or not, I specifically traced the interaction of checklists with existing professional routines. Professional work is structured by these routines that inhabit professional norms and values. Although checklists ask for connections between multiple professional routines, they often lead to incompatible demands for professionals. The interdependence with conflicting routines was found to be an explanation for variability in checklist performance. Clinicians developed three responses to deal with conflicting demands: work on it, work around it, or work without it. This study underlines the need for another perspective on medical checklists; they are not ‘simple’ coordinating instruments, but ‘hubs’—points where multiple and different professional routines have to connect.

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Notes

  1. 1.

    Although it must be said that compliance rates in studies that use self-registration data are a lot higher, sometimes even up to 99 or 100% (see e.g. Urbach et al. 2014; Fourcade et al. 2011). However, observational studies report compliance rates that hover around 30 per cent (complete checklist compliance) to 55% (partial checklist compliance) (e.g. Rydenfält et al. 2013; Van Klei et al. 2012). In later paragraphs we will further reflect on consequences of these different study designs.

  2. 2.

    The World Health Organization introduced the first version of this Surgical Safety Checklist, and explicitly encouraged hospitals to adapt this general format to their local circumstances. Therefore, the hospital under study transformed the ‘sign in’ check to a morning ‘briefing’ in which all patients of the day are discussed. More information on the Surgical Safety Checklist can be found on the WHO website.

  3. 3.

    Depending on the perspective of observation—shadowing either a surgeon or an anaesthesiologist—the number of attended performances of the checklist in a day varied from five, in the case of a surgeon who had to perform two complex vascular surgeries (one briefing, two time outs and two sign outs), to 24, when shadowing an anesthesiologists who had to take care of anaesthesia for seven operations in OR1 and four in OR2 (two briefings, eleven time outs, eleven sign outs).

  4. 4.

    Field notes taken when shadowing a surgeon.

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Authors and Affiliations

  1. Utrecht School of Governance (USG), Utrecht University, Utrecht, The Netherlands

    Marlot Kuiper

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  1. Marlot Kuiper
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Correspondence to Marlot Kuiper .

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Editors and Affiliations

  1. Cardiff Business School, Cardiff University, Cardiff, United Kingdom

    Aoife M. McDermott

  2. Cardiff Business School, Cardiff University, Cardiff, United Kingdom

    Martin Kitchener

  3. Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom

    Mark Exworthy

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Kuiper, M. (2018). Checklist as Hub: How Medical Checklists Connect Professional Routines. In: McDermott, A., Kitchener, M., Exworthy, M. (eds) Managing Improvement in Healthcare. Organizational Behaviour in Health Care. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-62235-4_8

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