Essay: Check under the tail… every time!

Once you have worked in veterinary practice for long enough you will have seen your fair share of preventable errors. As a practice owner there is nothing more frustrating than dealing with mistakes despite feeling that you have plenty of good systems in place and have given your staff ample training. Most practices have experienced that classic of veterinary surgery – the cat spey with no uterus that turns out to be a boy! It’s Murphy’s Law that the one day you don’t check under the tail, Charlotte turns out to be Charlie.

Of course, veterinarians do not have a monopoly on mistakes, as is obvious when reading American surgeon Atul Gawande’s rivetting book, The Checklist Manifesto. Clearly this is not the kind of book that you want to read just prior to having some sort of major surgery or, for that matter, any interaction with human health care services. Gawande’s book describes how healthcare has become increasingly complex to the point that “the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely or reliably”. The statistics he quotes on the error rates for various procedures in hospitals, some of them very basic, are quite scary. You can only think that there must be a staggering number of errors made every year in our industry if the sheer level of mistakes made in human healthcare is similar in veterinary care.

Fortunately Gawande presents his readers with a deceptively simple tool for reducing the error rate – the humble checklist. He cites numerous studies that give compelling evidence for the ability of a well-constructed checklist to make our hospitals significantly safer, keep our aeroplanes in the air and ensure our skyscrapers stay standing.

I am sure many people are already using the odd checklist in their businesses. Before I read this book I certainly had a few, but many of these were more like a written system or procedure. A checklist, however, is not designed to document a system or be a training tool; rather it’s a tool for everyday use and there are plenty of tips outlined in the book for ensuring that your checklists are concise, relevant and effective.

So, how are we implementing checklists in our practice? We initially started with the areas of the business where there are really critical things that must not go wrong, such as in the surgery. At the same time, when problems cropped up in other areas, we often dealt with them by discussion during a staff meeting followed by development of a checklist. Whilst Gawande specifically talks about using checklists for critical processes, we are also finding them useful for less crucial areas of the business – such as where it is important to get consistency of care between vets or where, for efficiency, it is really important that thing are done right, first time, every time.

In the surgery we have developed checklists for many critical processes such as the anaesthetic machine tests that we run each morning and prior to each surgery and for pre-anaesthetic examinations to ensure we don’t miss those testicles! Some of our checklists are visual, such as the checklists for our surgical kits, which are just photos of the instruments each kit should contain.

We have also extended the use of checklists to the consult rooms. Our veterinary software allows us to write history templates that can then be dropped into an animal record and edited. We have set many of these history templates up as checklists. For example, each of our puppy and kitten vaccination visits now has a templated checklist which acts as a great reminder for the vets to cover certain topics with the new pet owner at each visit. Having been away from the practice for some months on maternity leave I can now personally vouch for the fact that these checklists provide a great prompt for what to cover during the consult. No more blaming things on baby brain!

My practice manager has implemented her own checklists to make aspects of her job easier. She now has very thorough checklists for induction of new staff, payroll processing and end-of-day procedures. Other staff members have developed checklists for entering new products on to our computer system, what should be in our home visit euthanasia kit and more. Many of these checklists have been developed after we discovered repeated mistakes in a process that lent itself to a short checklist to prevent recurrence of these mistakes. We still have plenty of areas where we could implement effective checklists and it is great that the staff members have bought into the concept to the point where they create their own checklists for their specific tasks.

Implementing the ideas from The Checklist Manifesto has helped us to lift the bar on the quality of medicine we practise, the consistency of care we deliver and the level of teamwork in our practice. The possibilities for improving both patient care and business processes using checklists in veterinary practice are virtually endless! While I firmly believe that veterinarians need scope to treat patients as individuals and that not everything warrants a checklist, selectively introducing more checklists can only improve your business.

Paula Short

This essay was an entry in the In The Black Essay Competition for 2012.

Paula Short is the owner of Tasman Bay Vets in Motueka, New Zealand.

John Heath of Boehringer Ingelheim, Mark Amott of Southern Animal Referral Centre and the AVBA and Susan Halloran of In The Black judged the competition.

Visit for information about the In The Black Essay Competition for 2013.


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