The Check Sheet – Simple but powerful

January 19th, 2010

checklistI recently heard a gentleman talking about using check sheets, sometimes called checklists, in the surgery room of hospitals. His point, and I agree, is that check sheets can reduce errors and cut down surgery time for all most any surgery given. He stated that many surgeons think that the check sheet could not be used because every patient is different and thus every surgery is different. I agree that every patient is different and that during the “same” surgery on different people one has to constantly adjust to the circumstances. But in reality surgery is the same as most any other procedure. Most companies know that there is variation in everything and thus have to be ready, through robust procedures to adjust the process to have positive end results. Look at NASA, they uses check sheets for every flight and every flight is different and very dangerous, but they find they can not do without them. I think that if surgeons thought about it there are a lot of things that you do the same; at least the major steps. Plus as complicated as surgery is and with all the variations that occur you need a good check sheet to keep the complicated process steps in focus and not forget anything critical that one wanted to get done.

There are several types of check sheets and believe it or not we all use them almost every day; Shopping lists, grocery lists, task lists are all types of check sheets. This is why Check Sheets are one of the Seven Basic QC Tools. But the one check sheet that the gentleman above talked about; I call “Run Rules.” Why I call them Run Rules is that in critical or complex process you need a “cheat sheet” that is used all the time during the process run. In six sigma these, check sheets, are a control, to insure that changes that are put in place maintain the gains they were designed for.

Why are they needed if you have standard operating procedure? Because those are detailed and lengthy but extremely important for reference and those learning for the first time. For those that have been doing the process for some time, they are not now really look back to those procedures. They have them in their heads. In critical or complex processes , including surgery, there are something’s you want to make sure they are “in their heads.” They are things you really do not what forgotten. These go on the “Run Rules” or check sheet that everyone looks at daily as they are doing the process to insure everything gets done. So if everyone IS going to look at them you have to create them so they are the “go to” item when doing this process. Here are some guidelines for creating effective Run Rules/ Check Sheets.

They are:

  • Only a small but critical portion of the Standard Procedure applicable to the activity.
  • One page MAXIMUM.
  • Used as a reference for everyday use.
  • Key steps identified as value added for the customer.
  • On a Standard form so anyone stepping in recognizes them.
  • Easy to understand
  • Good for new employees and things you do not do that often.

 

In summary these Check Sheets/Checklists/Run Rules are your day to day reminders of the details in what you are doing.

Well I hope this has been informative. If you have questions drop me a line. Also you can learn how to build one in my article “How to build a good Check Sheet”.

Peter Bersbach
Bersbach Consulting
peter@bersbach.com
1.520.829.0090

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2 responses to “The Check Sheet – Simple but powerful”

  1. There is a very interesting discussion going on in the Wall Street Journal on Checklist that you might find interesting.

    http://online.wsj.com/article/SB10001424052748704320104575015294037289412.html?mg=com-wsj#articleTabs%3Darticle

    I agree with this article that Checklist do standardize our processes to reduce defects. But the reason we have people, and thus the need for checklists, vs a robot is when process/environment variation causes a problem or issue; we have someone there to think creatively and quickly to solve the problem.

    I think we, as humans, get hung-up on “Pigeon Holing” or categorizing everything. Using Checklist in every thing or not using them at all. What I really think both Mr. Howard and Dr. Gawande are saying is the same thing checklists are good in many situations but not everywhere. And when they are used we need to be ready to adapt to the situation and adjust the approach. They are guidelines for the process as we know it. No more and no less.

    I work as a Six Sigma Master Black Belt. What I see is that we need standardization to perform consistently at a given know level. The best efficiencies that we know at the time. But over time things change and we have to discover the shift and create a new approach to the shift. Sometimes that happens in an instant and we make instant changes to be successful ( as in the Hudson river crash) . Then we take a step back look at what happen and make adjustment to our standard procedures (checklists) if needed or possible so that the incident does not happen again.

    What I am really saying is we need both the standards to be consistent/ repeatable/ predictable and the creativity/ experience/ insight/ empowerment to take action when things change as they will at any point in time.

    Bersbach Consulting
    Peter Bersbach
    Six Sigma Master Black Belt
    http://sixsigmatrainingconsulting.com
    peter@bersbach.com
    1.520.829.0090

  2. […] an earlier article “The Check Sheet – Simple but Powerful” I talked about the power of a check sheet and how some use them. Here in this article I’m going […]