The Checklist DESIGN Manifesto

In the Checklist Manifesto: How to get things right, Atul Gawande makes an eloquent and compelling case for the use of checklists to help wrangle complexity. 

An array of people working in healthcare have been inspired to create checklists to aid memory, improve quality, and add consistency. Clinical research teams around the globe have been exploring how, when, and where checklists and similar clinical support tools can be used to help improve outcomes.

One of the most cited examples of checklists in medicine, the WHO Surgical Safety Checklist, recently celebrated its tenth anniversary. Over the course of that decade checklists have become common, but they have not gotten easier to use.

Too many clinical support tools are poorly designed

Of the many hundreds of checklists and cognitive aids I've reviewed, the vast majority fail to follow basic visual design best practices and many do not appear to have considered human factors at all. 

If the design sucks, the tools will be less usable. That’s lousy for the people trying to use them and it undermines what studies tell us about the efficacy of the tools.

I’m talking to you

The people I've met working on these tools are invariably smart, dedicated, and caring people. I’ll assume that you are here because you are working on your own tool, so let me say this:

You work hard to do your best, often on your own, usually with insufficient resources. You care about doing better, strive to follow the evidence, and persist like a champion even when change is a tough sell for your colleagues.

How to do better

This is a call to action. Join a movement to make care better by making better tools for clinicians, patients, and families.

Whether or not you have experience thinking about layout and design, systems and culture, there is a path to better.

It looks like this…

Because we embrace the challenge of making a tool that is practical and useful, we will...

Design for people

People are human, so we will think about “human factors” when creating tools for people to use.

We will consider how the human visual system and brain work, how people handle and hold things, how people interact socially and culturally, and how people go about doing their work.

We know that for our tool to be helpful, we must:

  • Make it easy to see, read, hold, and control — when and where people will use it.
  • Be rigorously consistent to help people navigate content.
  • Use concise, simple, unambiguous language to eliminate potential confusion.
  • Reflect local cultural conventions (terminology, tone, etc.) in content and format.
  • Test it and revise it — repeatedly.

Design with people

We will create a group of people to help us. We need them to explore early ideas, generate and test content, evaluate flow, refine visual design, and plan for implementation.

  • We will invite all roles whose work will be affected by the tool to have a voice in it's design and implementation.
  • We seek a diverse group (perspective, role, background, age, experience, etc.) to challenge and improve our ideas.

Design for change

People live and do their work within complex systems that are often unpredictable, sometimes irrational, always intertwined, and constantly evolving.

  • We will identify how our tool fits into a broader context and consider the ways it may affect other people and processes.
  • We will plan for unanticipated consequences; we won't know what they are (obviously), but we can define a process for dealing with them.
  • We accept that we will have to modify or update our tool periodically, and we will define an explicit time period and process for doing so.

Design with kindness

We know that in an imperfect universe (like this one), compromises in design are necessary, but we will not solve our design problems on the backs of the people using our tool. That means:

  • We will work hard to resolve content, space, budget, and other design problems in ways that do not make it harder for people to use and benefit from our tool.