Several years ago I became familiar with a great book called “The Checklist Manifesto” by Atul Gawande and began incorporating some of the ideas into my practice. I am hopeful that the concept of using checklists is becoming more popular in dentistry. The cover story of this month’s Journal of The American Dental Association is entitled “Designing a Safety Checklist for Dental Implants”, so maybe the idea is catching on. The book uses a system incorporated by airplane pilots to minimize risk and increase the successful and safe completion of flights, a checklist. This idea was then incorporated into hospital and medical protocols with dramatic results and improved patient outcomes.
The basic premise is that as our worlds and systems become more and more complex, the answer to success is as old and simple as having a checklist and a system to use it every time. The more complex a task becomes the easier it is to forget or overlook any single step. In addition the more calamitous it can become on the result when a step is skipped. For many of us we think these complex and multi-step systems are too complicated and sophisticated to breakdown into a checklist, but in truth everything can be.
So could checklists help improve patient outcomes, or the simple day to day operations of your office? We use checklists in our office for complex procedures like bonding in porcelain veneers, where skipping the step of applying silane can cause the restorations to fall off prematurely. We also use checklists for office systems like cleaning and servicing the vacuum suction, or restocking our procedure kits. One of the challenges of using checklists is not ever letting yourself think you no longer need them. No matter how long you have done a process, or how many times, we are all capable of not getting all the steps. A simple distraction can cause you to lose your train of thought or place and then pick up one step too far ahead. Checklists give us certainty that we are true to the process and reassurance that we will produce successful outcomes.
So, where can you implement a checklist?