Checklists are synonymous with the airline industry and, more recently, health care, with the World Health Organization’s adoption of a Surgical Safety Checklist. More and more health care organizations are adopting a checklist mentality in the development of clinical pathways. After reading The Checklist Manifesto by Dr. Atul Gawande, we wondered if a checklist could be useful in pediatrics to create the best interactions among patients, families, and caregivers.
Clinical checklists are built upon empirical evidence of their effectiveness. Our dilemma was figuring out what, if any, empirical evidence was available to create an experience checklist for pediatrics. We sought to answer a single question: how could we determine what patients and families want during an interaction? Our answer was simple: ask them. Our research plan consisted of:
- Asking 250 families the top three things a care provider could do for them to judge the interaction as excellent.
- Shadowing top-performing care providers and lower-performing providers, drawn from the Care Provider section scores of the Press Ganey Medical Practice survey.
- Interviewing the top-performing care providers to understand their philosophies and tactics.
- Reviewing 1,700 Press Ganey survey comments from the top 30 and bottom 30 performing providers.
We focused on the non-clinical aspects of the interaction. Putting emphasis on the personal interaction does not supersede the importance of accurate diagnosis and treatment. Families expect both — diagnostic acumen and empathy and compassion in their physician visits.
The result was the following checklist:
- Sit down so you’re eye-to-eye with the child and family.
- Greet the entire family and use their names if known. At minimum, use the child’s name.
- If delayed, say, “Thank you for waiting for me” instead of “I’m sorry you waited.”
- Talk about at least one non-medical topic with the child or family prior to addressing the medical issue. School, hobbies, sports, etc.
- If the child is old enough, ask him or her questions about the medical issue.
- Learn something you can use during future visits. Make a note of it in the EMR. For example, if a child mentions going to an upcoming sporting event, make yourself a note to ask him or her about it the next time you see the family.
- Don’t interrupt the child or family. Listen while they talk.
- Ask, “What questions do you have for me?” instead of “Do you have any questions?”
- Thank the family for giving you the opportunity to care for their child.
Early feedback from physicians is positive. We are currently collecting quantitative data on the impact of the checklist. The mother of a child whose physician started using the checklist noted a “night and day” difference in the experience. Remove the word “child” and replace with “patient,” and this checklist can be applied to adult medicine. Consistent application of this list takes practice, but everything in it is common sense. Although created with a rigorous and thorough research process, the checklist was intentionally written to be simple. Sometimes the best solution is the simplest.