Beyond the Checklist

Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork.

Suzanne Gordon is Visiting Professor at the University of Maryland School of Nursing and was program leader of the Robert Wood Johnson–funded Nurse Manager in Action Program. She is the author of Life Support and Nursing against the Odds, coauthor of Safety in Numbers and From Silence to Voice, editor of When Chicken Soup Isn’t Enough, and coeditor of First, Do Less Harm and The Complexities of Care, all from Cornell. Patrick Mendenhall is a Principal in Crew Resource Management LLC who is a pilot for a major commercial airline and belongs to the Air Line Pilots Association. Bonnie Blair O’Connor is Professor of Pediatrics (Clinical) and Associate Director, Pediatric Residency, at Hasbro Children’s Hospital/Alpert Medical School at Brown University.

This book is full of information from air investigations and interesting facts. The first flight attendants, for example, had to be registered nurses in case any passengers became unwell. It shows that the everyday implementation of such things as checklists is part of a commitment by an industry to change the way it works. This commitment comes through leadership, but involves all the team, and is key for a nursing audience.

Jan W. Steenblik:

An excellent account of the history of crew resource management (CRM), its virtues, and how it's supposed to work, the book also delivers an eye-popping look beyond the supposedly sterile drapes in some of the United States’ most prestigious hospitals. Approximately 100,000 patients die in the U.S. every year as a result of medical mistakes, and some of the behavior that goes on in the U.S. healthcare system, as described in the book, is appalling. 'Health care needs... a radical cultural transformation, like the one that has taken place in aviation over the past 30 years,’ the authors argue persuasively. Three positive case studies show that it can be done.

Lucian L. Leape, MD, Harvard School of Public Health:

This is the fascinating story of the development and implementation of Crew Resource Management (CRM) in aviation and how it can and must be employed in health care. In spite of differences between aviation and health care, the similarities are more striking. Both are intrinsically hazardous endeavors, with complex technology, and dominated by one profession. Both developed a dysfunctional hierarchical culture that substantially increases risk for its customers and patients. Aviation has done something about it: CRM, with dramatic results. Flying is now incredibly safe. The lessons are clear, the cause is urgent, and the time has come for all health care organizations to act accordingly.

Heather M. Young, RN, FAAN, Betty Irene Moore School of Nursing, University of California, Davis:

This important book brings both a sense of urgency and the hope of clarity in addressing a fundamental and widespread problem in health care. It is a must-read for clinicians and students who deliver care and a call for leadership from every member of the interprofessional team. Leadership is required to change the culture and systems of care delivery. Beyond the Checklist provides the inspiration and a path for that change.

Theresa Brown, RN, clinical nurse and author of Critical Care:

This book is a revelation! Anyone who believes that toxic hierarchies and dangerously ineffective communication are inevitable in health care should think again. Beyond the Checklist heralds a new kind of hospital workplace—one that's already been flight-tested. The dysfunctions of our health care system are tragic and unnecessary, but they can be fixed. This book shows us how.

Sean P. Clarke, RN, PhD, FAAN, McGill University School of Nursing:

The ideas presented in this book are so clearly developed and the writing so engaging that its audience will not be limited to patient safety experts. Patients, their families, and health care providers of all kinds will also benefit from the authors' insight into hospital safety improvement. The case studies are rich in detail and full of critical reflections on the connection between quality care and optimally functioning teams. The tone of Beyond the Checklist is hopeful but, for good reason, very urgent as well.

Terry R. Rogers, MD, The Foundation for Health Care Quality:

The deeper I progressed into this terrific book, the more embarrassed I became for my profession of medicine. Behind our casual assumption as airline customers that we will arrive safely lies an enormously complex process that addresses all human and system issues that could possibly affect safety in air travel. With a few notable exceptions, we in medicine do not come anywhere remotely close to where we need to be to assure our patients of this same kind of safety commitment. There can be no excuse for medicine not pursuing this same all-engaging, relentless process. Our patients deserve nothing less. This is a must-read book for anyone with any connection at all to the delivery of health care services.

Julia Hallisy, DDS, The Empowered Patient Coalition:

Some experts downplay the parallels between health care and aviation, but there is much we can learn from the system-wide change that greatly improved passenger safety on commercial airlines. This excellent book highlights the innovative programs of pioneering hospitals where better teamwork and effective communication guide every interaction—from the bedside to the boardroom.

Robert L. Wears, MD, University of Florida and Imperial College London:

Beyond the Checklist takes us behind an apparently simple tool to lay out the complex social and organizational transformation that makes the checklist effective in aviation and to argue for a similar top-to-bottom transformation of health care. By shifting our attention to the detailed, sustained, and careful work that will be required to make health care safer, the book moves us forward on a long, difficult, but ultimately rewarding journey.

Michael W. Leonard, MD, Co-Chief Medical Officer of Pascal Metrics and Adjunct Professor of Medicine at Duke University:

Beyond the Checklist helps us understand that successfully providing safe and reliable care for our patients requires a multifaceted approach. Mechanisms such as checklists need to be integrated with effective leadership, teamwork, knowledge about human factors, and continuous learning. This book provides valuable insights on a journey that will provide a better care experience for patients, their families, and the people providing care.