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Checklists: Why cops need more of them

This is an article i have been meaning to write for at least a year, if not longer. The question i want to pose to the police service is; how can police checklists save lives?

Firstly, I want to make a distinction between two separate arguments here. The first regards the unnecessary and defensive bureaucracy that suffocates police officers and police staff alike. This is not what i am talking about. The second argument, which i will be advancing in this blog post, is that there is a large body of evidence that the police service cannot ignore that supports the use of checklists. In this blog post i will be looking at two professions that have got check listing right, and one that have got check listing very wrong.

I define a successful check listing system as that which supports professional judgement, and increases competence. An unsuccessful check listing system is one that deskills the professional.

The first service i am going to look at is the UK Ambulance service. They have a computer aided dispatch (CAD) system which is entirely reliant on checklists and leaves no room for professional judgement. Every question is scripted, and every answer is scripted. The answers given by the caller dictate the type of response they get. This type of checklist system may have huge advantages when dealing with life and death situations, but what happens when the unexpected happens? Having been deskilled, i believe the ambulance control room is at a disadvantage.

The next two professions I'm looking at have mastered the use of checklists; airline cockpit procedures, and the NHS.

So lets remind us of the initial proposition; badly managed checklist systems lead to the de-skilling of the professional.

Airline pilots. They have checklists for every possible eventually. The checklists are familiar to them because they practice them in a simulator on a scheduled regular basis. The checklists are designed to prompt them, and are not an exhaustive list of everything they must do…after all, these are highly skilled pilots but due to the sheer quantity of possible emergency stations, they have checklists available to prompt them. A great example of this is US Airways Flight 1549 where the Captain faced a double strike to the engines by Geese that resulted in the failure of both of the engines. Bird strikes are fairly common, and sometimes they lead to one engine failing. But for both engines to fail as a result of a double bird strike is incredibly rare and there wasn't a checklist written on how to deal with it. Captain Sullenberger relied on his extensive experience to perform a miracle landing on water with not a single fatality.

An aircraft is so complex, no matter how skilled the pilot, they will always benefit from prompts by way of checklists. Yet any checklist needs to increase the competence of the professional, rather than decrease it.

The next profession i am going to take a look at is the NHS and their process of 'hand off', which is where a patient is transferred from the care of one team to another. This issue has been of such international concern that the World Health Organisation has published a lot of guidance on how to ensure the best handover, which results in better patient care, and less unnecessary deaths.

Medicine is an environment that is very prone to interactive complexity, or the swiss cheese effect.

Here is an extract of a real life critical incident review;

A simple handover checklist would have prevented this by identifying the reasons for the blood test, which would have then resulted in staff understanding the importance of the blood test.

Continuing to look at the NHS, there is another place where continuity is even more essential; surgery. We have all heard about the wrong kidney being taken out and other examples of surgical mistakes. But just take a look at this form for a minute. You will probably find it a little overwhelming, but this form isn't completed all in one go. The checklist starts when the patient is on the ward, and follows the patient all the way through the surgery and back to the ward. In the middle of the document you will see a page entitled "I pass the baton". This is a wonderful tool as everyone uses this one handover format, leaving no room for confusion.

HandOff SampleTools

So we've looked at three example professions. We can see that the medical profession have pretty effectively solved the checklist problem...their checklists are extensive, but when one piece of paper is following that patient from beginning to end, is it really that bureaucratic?

We've looked at the high pressure environment of an airline cockpit where decisions need to be made very quickly, and the checklists are designed in a manner to ensure a pilot can get to the right checklist as soon as he needs it.

Is the pilot any less skilled because of checklists? In my opinion, the answer is a resounding no.

So why do some professions get it so right, and others get it so long? The answer to that is how incidents are dealt with ex post.

When a plane has an emergency, it is investigated to make sure it doesnt happen again. There are often examples where it is found to be pilot error, but you won't see a lynch mob seeking justice. You will usually see the industry finding a way to avoid that pilot error in the first place, and that is generally additional simulator practice. What matters is that is doesn't happen again, and it is very very rare for a pilot to be arrested for his mistake.

In the medical profession, you very rarely see doctors or nurses being prosecuted for their part in an accident or incident. The NHS is very good at identifying systemic problems and solving them, rather than seeking a scape goat.

The Police, on the other hand, are at the mercy of the IPCC, and this is why the police can never have a successful checklist system that meets the standards of the airline profession or the medical profession. One of the IPCC's stated objectives is to idenfity if any police employee should be prosecuted for their role in an incident, which leads to individual officers and staff feeling vulnerable and therefore creating defensive policies resulting in a huge amount of paperwork produced for no real purpose.

So if the Police want to follow in the footsteps of the NHS and the airline industry, the IPCC must become inquisitorial rather than adversarial when investigating police incidents. At the moment, it is the IPCC itself that presents an unnecessary risk to the police and the public and needs to change.