Using Checklists to Mitigate Error and Injury

Today’s utility crews are working in an increasingly complex and fast-paced environment. Utilities and their contractors have come under intense pressure to get work done quickly and to ensure that it is done without error or serious injury. With this increased pressure comes increased risk.

So, how can we reduce the possibility of error on our worksites given such a demanding environment? One simple way is to use checklists. I realize this is hardly a new concept, but my colleagues and I have found that checklists, when properly written and consistently used, are a proven method to reduce risk and error.

The power of the checklist is well-documented in Dr. Atul Gawande’s book “The Checklist Manifesto,” published in 2009. Gawande, an endocrine surgeon, found that on average, there were over 50 million surgeries performed each year in the United States. Alarmingly, 150,000 of the patients died after surgery – and half of those fatalities were avoidable.

In response, the World Health Organization convened a two-day meeting to consider how to reduce the complications from the more than 230 million major operations that are carried out worldwide every year. Instead of creating more policy, they created a series of surgical checklists. They tested those checklists in eight hospitals around the world in 2008, and the results were stunning. Major complications from surgery fell by 36%. Post-surgery deaths fell by 47%. Infections fell by almost 50%. Was there resistance to the use of checklists by highly skilled surgeons? Of course. But the results were worth the effort.

Types of Checklists
There are essentially two types of checklists. The first is a sequential checklist sometimes referred to as a “read-do” list. Tasks on the checklist typically must be performed in a strict sequential order.   

The second type of checklist – sometimes called a “do-confirm” list – is more general, often organized by environment or activity. One example is an airplane checklist on which items are organized by phase of flight. For instance, a landing checklist is a collection of items that need to be completed prior to landing. Often it is not critical in what order items are completed, just so long as they are completed prior to moving on to the next flight phase. 

Where to Begin
Creating checklists usually requires brainstorming in a team environment. My colleagues and I recommend forming a design team made up of a cross-section of your company. That way you get the perspective of management, field leadership and those doing the work. We caution against allowing your design team to get too large as it then becomes difficult to reach consensus.

Recently, my colleagues and I were asked by a utility to lead a three-day roundtable with the goal of eliminating serious injuries and fatalities associated with vegetation management. The utility gathered top field and safety leadership from each of their primary vegetation management contractors. The result was a series of checklists, organized by activity, clearly defining each hazard and mitigation. The checklists were bound into field guides that were distributed to crews, field leaders and observers across the property.

Following are the three steps we used to develop the checklists. 

1. Focus on One Activity or Environment at a Time
We started by defining each activity and environment associated with vegetation management. For instance, some of our activities included working with a chipper, working adjacent to traffic and tree felling.

There is no exact science behind choosing the breadth of your activity. However, you should avoid the temptation to become too general (e.g., compliance tree trimming) or too granular (e.g., fueling a chainsaw).

Once we had defined our list of activities and environments, we moved on to primary hazards. 

2. Identify the Primary Hazards Associated with Each Activity
Primary hazards are threats that, if left unmitigated, could lead to serious injury or a fatality. For instance, when considering using a chainsaw aloft, primary hazards include laceration, dropped branches and a dropped chainsaw.

Resist the temptation to jump to mitigations or regulatory requirements at this stage. Allow your team to thoroughly explore the primary hazards associated with each activity. We analyzed over 200 serious injuries and fatalities associated with vegetation management, organizing them by activity and primary hazard, which helped refine our efforts. 

3. Determine at Least One Mitigation for Each Hazard
For each primary hazard, agree upon at least one mitigation, also referred to as a critical observable action. These mitigations must be essential to the control of the specific hazard, and they must be observable. Mitigation sources might include any or all of the following: company safety policies, regulatory requirements, consensus standards, industry best practices and years of experience.

Be sure your critical observable actions are clearly defined and easily understood by those doing the work, those leading the work and those observing the work. Be sure each item on your checklist mitigates a specific primary hazard. Avoid the temptation to create a distilled safety manual. Do your best to limit each primary hazard to no more than five critical observable actions.

Conclusion
Finally, be sure your checklists are accessible and well-organized. My colleagues and I prefer to organize our checklists by activity and environment for easy reference. We typically print them in a spiralbound format on durable paper.

Checklists, as simple as they are, will help eliminate serious injuries and fatalities associated with your activities and environments. We can think of nothing more important.

About the Author: Thomas Arnold, CSP, CUSP, MBA, has been a principal consultant with Professional Safety Solutions since 2009. He can be reached at tom@prosafellc.com.