We stand at the foot of Cathy’s hospital bed and watch with concern as tubes drip antibiotics into left arm her vein.

The nurse enters with her iPad and checks off items from her list as she attempts to engage Cathy in conversation and check her vital signs.

• “Do you know what day this is?”
• "Do you remember how you got to the hospital?"
• "What meds do you currently take?”

The litany of polite questions goes on for a few more minutes as she checks Cathy’s temperature, pulse, etc.

Her checklist, now on a hospital iPad, began back in 1935, from a simple piece of paper, ensures that all of Cathy’s health information is recorded.

Simple. Necessary. Lifesaving.

The simple checklist was birthed out of disaster.

In 1935, the U.S. Army Air Corps organized a competition among aircraft manufacturers, to select the best long-range bomber.

The Boeing 299, with its 103 ft wingspan, and four engines, was the winner.

It carried five times the number of bombs that the army had expected, with an ability to cover twice the distance of the previous bombers.

But as this marvel of aviation engineering was taking its maiden flight, something went wrong. It ascended about 300 feet and came crashing back to earth. Two crew members, including the pilot, died.

Crash investigation claimed that the accident was due to the pilot’s error, and that the plane was flawless in its design.

The Boeing 299 was way more complex than any of the previous planes the world had ever seen.

The plane required that the pilot look and analyze four engines (each with a separate oil-fuel mix), the wing flaps, landing gear, speed-propellers, etc.

In all the excitement and chaos of this first flight, the pilot, Major Ployer P. Hill had forgotten to release a new locking mechanism on the rudder and elevator controls!

Considering the long experience of Major Hill as the Air Corps’ chief of flight testing, the conclusion was drawn that it was humanly impossible to take control of such a complex machine.

The newspapers termed The Boeing 299 "too much airplane for one man to fly."

The Boeing Company was on the verge of bankruptcy and desperate. Then they came up with an ingenious idea – a checklist!

That was a simple list of points containing short, specific instructions to aid the pilot’s memory on takeoff, landing, taxiing and even during flight.

That simple solution allowed the U.S. Army to fly The Boeing 299 for 1.8 million miles, without a single accident.

The U.S. army ordered 13,000 of those aircrafts and renamed them "B-17." Flying them was credited as giving us a great advantage during World War II, which helped to conquer the Nazis.

While the aviation checklist proved pivotal in winning WWII, it proved a life saver in the field medicine as well.

The first checklists were introduced by the medical, nursing community in the 1960s, when nurses realized the importance of writing down all the patient’s vital signs, i.e. pulse, blood pressure, temperature, and respiratory rate.

Nurses developed charts to specify the medication timings and treatment plans of patients.

These were nothing but checklists.

Then came Dr. Peter Pronovost, PhD, FCCM, a world-renowned patient safety champion, physician executive, critical care physician, and prolific researcher with more than 1000 peer-reviewed publications, based at John Hopkins Hospital.

In 2001, he asked the nurses to design a checklist to prevent central line infections. Central line infections were a common and deadly problem in ICUs, leading to numerous patient deaths.

It resulted in a list that looked like this:

1. Wash hands with soap.
2. Clean the patient’s skin with chlorhexidine antiseptic.
3. Put sterile drapes over the entire patient.
4. Wear a mask, hat, sterile gown, and gloves.
5. Put sterile dressing over the insertion site once the line is in

Dr. Pronovost then asked the nurses to observe the doctors for one month as they put in the central lines and monitor whether they carried out each step.

The nurses observed that in more than one-third of the patients, at least one step was skipped.

The following month, Dr. Pronovost cajoled the hospital administration to allow the nurses to stop and correct the doctors whenever they skipped any step, and to ensure that the mistake was rectified.

Within a year, the 10-day infection rate fell from 11% to zero. The checklist had prevented 43 infections, and 8 deaths!

And the cost savings was over two million dollars!

The checklist was introduced to the whole state of Maryland, and slowly creeped into every health institution around the world, as part of basic care.

The standard of basic care improved tremendously with the use of a piece of paper with little square boxes to check. It listed the minimum necessary steps to be completed, regardless of how ridiculous it looked.

The sophisticated or erudite may scoff at using a list. We all think we can’t forget the basics until one day we do.

During high stakes, times of stress or frustrating circumstances, a missed step or missed opportunity can be prevented by using checklists.

Cathy left The Washington Hospital Center 10 days later with a list (of course) of meds, physical therapy dates, and foods to avoid.

Checklists are our universal helpmates.

They help:

1. Standardize procedures and processes.
2. Organize complex projects.
3. Break down larger tasks into smaller, manageable steps.
4. Prioritize tasks by identifying what needs to be done first.
5. Facilitate communication within teams.
6. Onboard new personnel.
7. Reduce stress and anxiety by offering visual representation of progress.
8. Learn new skills or reinforce existing ones.
9. Aid memory by ensuring that all necessary steps are considered and completed.
10. Make changing requirements easy and versatile.

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