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In retrospect


The maritime sector can still learn so much from others...

 
We can all learn from others...

We can all learn from others...

There are many folk in the maritime sector who, probably because they’re so experienced, seem to eschew the use of checklists. I often hear sneering remarks made by senior staff about a ‘checklist culture’ as though that implies something that’s simply stupid or unthinking.

Checklists, I suggest should be used much more widely than they are in the maritime sector. There are many processes and situations that would easily benefit from transparency, standardisation and repeat-ability. Yet we often seem to rely on the ‘Fred-does-it-because-Fred-knows-best’ approach – this is inefficient and costly.

I thought it’d be worthwhile relating my own recent experience of checklists in a completely different industry. I had reason to be grateful for their use and the peace-of-mind they gave me, the ‘customer’. In the maritime industries we still have so much to learn from others.

Modern healthcare is an industrial process just like shipping or any other. Whether we like it or not, when we go into hospital for surgery we submit to a process. Like shipping, probably dozens of individuals are going to get involved in our care. Some of those people will have direct continuous involvement in our care and others will have more peripheral roles – so, just like shipping, how can and do they all come together to provide an efficient total care package?

Key personnel such as the consultants and doctors, need to quickly get an informed overview of a patient’s status as they consider their initial needs and move between wards. Nursing staff who change from one shift to another need to track what’s happened to a patient while they’ve been off-shift. The sheer volume and type of data recording and transfer of information that’s required is only possible, I suggest, by using checklists.

When I recently went into hospital for urgent tests, and subsequently major surgery, I found myself taking a great deal of interest in my care and quickly noticed the extensive use of checklists made by my care team. I had many opportunities to note the type, detail and regularity of the data recorded and the subsequent decisions that were made based upon the data recorded in those checklists. I’m sure I was a bore for the hospital staff because I asked many of them how they went about their jobs, what tools they used and what helped them the most in their work. I even asked them if they’d read Atul Gawande’s The Checklist Manifesto – and none had!

What fascinated me most, when I wasn’t dwelling on my own physical problems, was how everyone functioned by using checklists – from the investigative and surgical teams right down to the cleaners. But none of my care team cited checklists as a valuable tool for their work. It’s not that they didn’t think they were important, it was just that their use was so ingrained, so second nature to them, that they didn’t think about them as a ‘tool’ at all. I think that was a function of the high standard of NHS training.

It was reassuring to me, as a patient, to see surgical staff preparing me for surgery by using checklists – during surgery of course I was unconscious, but kind souls reassured me that they use them throughout surgery too!  Afterwards, nursing staff checked to see what had been done to me while they’d been off-shift. It was reassuring to see each shift change being managed in exactly the same way with care staff gathered at the end of my bed discussing my status and immediate care needs together and using the checklist as the basis for that discussion. While it’s probably obvious in retrospect, I was amazed that they even recorded what I ate and, most significantly, when I said I didn’t want anything to eat at all.

I was confident, throughout my lengthy stay in hospital, that everyone knew what needed to be done, where to go to record data and where to find information about me if they needed it. I’m confident that the speed and nature of my recovery was due in no small part to the use of checklists.

In my view, the use of checklists gave the nursing staff the opportunity to ‘free up brain space’ and afforded them the time to use the softer skills of nursing such as listening and caring. Not only was I looked after physically I actually felt cared for – those feelings I have about my treatment could easily be described as customer satisfaction.

It doesn’t take a great leap of imagination to understand how any sector or process in the maritime industry could benefit in terms of cost savings, productivity and HSE enhancements, through the intelligent and wider use of well-designed checklists. We should watch others more closely and learn from them.
 

 
Simon Beechinor