This podcast is brought to you by PAR. PAR offers the SPECTRA™Indices of Psychopathology, a hierarchical-dimensional look at adult psychopathology. The SPECTRA™ is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com\spectra. For a limited time, you can get one free administration and score report for the SPECTRA™ on PARiConnect by calling PAR at 855-856-4266. Just mention promo code S-P-E-C.[00:01:00] All right, everybody. Welcome back to The Testing Psychologist.
Today’s business episode is called a Checklist Manifesto Approach to Testing. For any of you who have read the book, The Checklist Manifesto by Atul Gawande, this will sound familiar. I really enjoyed this book. This book was written by a surgeon, Dr. Gawande, and it really came out of his desire to understand more about the mistakes that get made in medical practice. He’s a surgeon and mistakes in the operating room can range from mundane to deadly.
The book is super interesting. It really details his research into checklists and what [00:02:00] might be helpful to eliminate or at least reduce mistakes in the operating room. And granted we are not conducting surgery, but we are working in a capacity where we follow relatively consistent processes from day to day, and yet we make mistakes all the time. It might be forgetting to administer a test that we wanted to administer. It might be sending out a report with grammar or client name mistakes, things like that. And so I really got into this book as a means of trying to learn how to streamline our processes and make them more consistent and eliminate or reduce mistakes in testing. That’s what we’re talking about today.[00:03:00] Now, if you need CE credits for your license, The Testing Psychologist podcast is available for CEs at athealth.com. You can search The Testing Psychologist and find most if not all of the clinical episodes available for CE credits. So check that out if you need CEs.
Okay, let’s jump to my discussion about making checklists to cut down on our mistakes.
Okay, everybody. Let’s dive into this topic of checklists.
You might already be thinking to yourself, why are we [00:04:00] talking about checklists? Checklists are super simple. I already know what I need to do. And if you are that person who already has well documented and frequently monitored and checked and adhered to processes, then this episode may not be for you. But the vast majority of us in the field of psychology and in other fields as you will find out, do not rely on checklists as much as we should.
I mentioned in the introduction that this episode really draws heavily from the material in a book called The Checklist Manifesto by Atul Gawande. So as I mentioned, he is a surgeon and has written a number of books and done a lot of work in this area of figuring out why mistakes happen and what to [00:05:00] do about them. So, if that is as interesting to you as it is to me, you can check out his books on Amazon or wherever you get your books.
The others are called Better: A Surgeon’s Notes on Performance and Complications: A Surgeon’s Notes on an Imperfect Science. He has also written a book called Being Mortal: Medicine and What Matters in the End, which was a really powerful book for me to read. I really like his writing style. I love that he is focused on this kind of thing.
But the book that we’re going to be really talking about today is The Checklist Manifesto. I got interested in this because I think like a lot of us, I noticed that in spite of theoretically having pretty rote processes that we go through in our practices [00:06:00] that we do day in and day out, there are a number of mistakes that get made. Some of those mistakes are small. Some of those mistakes are quite large. So the hope with this episode is that we might talk through some common checklists that you can include in your practice. We’ll define a checklist and what the important components are. We’ll try to really put this into play in a testing practice so that you can get more consistent and hopefully cut down on some of the mistakes that happen.
First of all, let’s just talk about what a checklist is. You might be thinking as I was before I read this book that a checklist is something that’s more complicated than it actually is. So, to that end, I will put this to bed right [00:07:00] away. A checklist is actually very simple. It’s exactly what you think it might be. It is an electronic or paper document that details a short series of steps or objectives that you want to be carried out for a process to happen or before taking action. So it’s really quite simple.
Now, there are two kinds of checklists that you can choose from that he talks about in the book. One of those is a do-confirm checklist. And this is exactly what it sounds like. You do the task usually from memory and then you go back to the checklist and confirm that you completed that task. You check it off. That works fine. The other type of checklist that’s available is a read-do [00:08:00] checklist. So this is the opposite. This is a checklist where you read the task, you go do it and that’s it.
So it’s simply the order that you choose to go in. I personally prefer a read-do checklist. That’s just because I don’t personally trust my memory very much, and I’d rather confirm that I’m doing the right thing ahead of time. So, I prefer a read-do checklist. A great example of a read-do checklist is usually a recipe where you’re reading the steps, you do them, then you go to the next step and you do that, you go to the next step, and so forth. But both types of checklists can work. It’s just whatever you prefer.
Now, thinking about why we might use a checklist. There are many reasons. [00:09:00] The reasons that I’ve already given are that it’s really easy to make mistakes. And we can honestly lull ourselves into thinking that we are much better than we are at remembering the things that we’re supposed to remember. We can do things rotely over and over and over, and unfortunately, even when we remember the steps that we’re supposed to do, we can still skip them, which is one of those problems with memory and action that just comes. It’s like it’s unfair, right? Like that’s not supposed to happen, but it does happen a lot. And I can speak to this for many examples in my life where I theoretically remember everything that I’m supposed to do around the [00:10:00] house or during testing or whatever it might be but I still skip those steps. It’s ridiculous. So that’s another good reason why we might want to do a checklist.
Another reason to consider is that… and he makes this argument that for many processes, you can do a really, really good job. You could in fact perform the entire process perfectly, but if you miss one component, you may as well done it at all. And he gives the relatively extreme examples of say, a pre-flight checklist for plane takeoff, certainly checklists in surgery or in the operating room. There are any number of things that if you forget one thing, you may as well just thrown the whole thing in the trash because it’s going to be a pretty severe outcome.[00:11:00] I don’t think that we are luckily quite in that boat with testing, but the same process or the same idea can apply where if you do a fantastic job writing a report and the conceptualization is on point, the recommendations are amazing, you somehow confirm that you have made exactly the right diagnosis, but you don’t replace the placeholder for the first name or last name or heaven forbid you put the wrong client’s name in there, that can ruin the whole report. I mean, it shouldn’t, the content is still great, but in terms of the client relationship, it’s almost like, well, why did you even write that report in their minds?
So just a couple of reasons why a checklist can be helpful. And he goes into a lot of detail in the book [00:12:00] about why we need checklists. One of the interesting points just before I move on is that he talks about how we are in a really interesting place, just culturally where we have so much knowledge at our fingertips really and so much knowledge stored in our heads that it’s exceeded our ability to implement that knowledge consistently, reliably, accurately, those sorts of things that this influx of knowledge that we have, this amount of learning that we can do is both a curse and a blessing. So a checklist is a step that will help tone down some of those errors.
What are some characteristics of a good checklist? The [00:13:00] main theme is that the checklist is user-friendly. So again, it seems pretty simple, but what does that mean? The checklist needs to be short. Those of us doing testing, which is all of us I’m guessing, can get on board with this.
He really plays into the idea that we can only hold a certain number of items in our working memory. So he recommends that the checklist falls between 5 to 9 items long. It should be relatively short. It should be very clear.
A good checklist is not going to have items on it that have jargon or overly lengthy sentences. An item on a checklist should fit on one line except in some rare [00:14:00] cases. So it should be simple. It should be succinct. It should be very clear. There should be no doubt about what to do from reading the items on the checklist. And again, this might seem intuitive, but maybe you’ve done this as well. I mean, I’ve tried to write a number of processes or explanations or lists and it can be hard to trim down the content sometimes. So should it be short, succinct, very clear. It should also be aesthetically pleasing which means that the checklist should ideally fit on one page.
If you’re doing it electronically, the same thing applies. You should not have a multi-page checklist. You should pick a font that is easy to read. You should make the font large enough that you can actually read it without having to put forth a lot of [00:15:00] effort. So, small things like this are all going to go into creating an effective checklist.
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All right, let’s get back to the podcast.
So let’s talk about some examples of checklists that we can put into place in our practices. Now, y’all may remember, I’ve talked to a number of times about systems [00:17:00] on the podcast and I think most recently had Natasha from Systems Rock on the podcast. And so when I think about checklists, I really think there’s a lot of overlap with the systems that we put into place or really processes.
The three that came to my mind right off the bat are a client onboarding checklist. So how do you get clients into your practice? What are the crucial components that need to happen to both convert and schedule and onboard a client. I think about a testing checklist or a battery selection checklist, you might call it a testing preparation checklist. And I think a big one that can easily get overlooked is a report proofreading checklist.[00:18:00] So I would say of all of these, I probably wrote a report proofreading checklist before anything else simply because when I started to hire folks in our practice, I found that some intuitively knew how to proofread a report and were pretty meticulous and some were not, particularly our trainees. So this really came from working with trainees all the way from prac student up through post-doc and a report to proofreading checklist has been really helpful in just training them on expectations before we send out reports.
So those are the three types of checklists that I think we can put into place in our practices right off the bat.
When I think about a, let’s say client onboarding checklist, that’s going to[00:19:00] vary depending on the practice of course, but these are just basic things like gather demographic information, schedule the client’s first appointment, send a confirmation email, check a client’s benefits, send them intake paperwork. Basic things like that. But it’s amazing how often we can forget to do these things. I’ve been guilty of this myself.
As far as a testing checklist, we could get very granular with a testing checklist. And like I talked about just a bit ago, it’s really nice to keep your checklist to more like 5 to 9 items. So, for me, at least the testing checklist and the report proofreading checklist are pushing the 9-item limit. But I think with a little work, you can get your checklist down to [00:20:00] that 9-ish item range.
So a testing checklist might be, first of all, gathering your materials. So making sure you have all the basics: clipboard, stopwatch or phone, blocks, manipulatives, anything that you need to administer the test. This would include also response booklets, manuals, anything you need to administer the test.
But before you can do that, you have to figure out what tests you’re actually going to administer. So we actually have a battery selection sheet that we use. And on that sheet, it has the vast majority of measures that we might administer, [00:21:00] again especially with trainees, but I still do this to this day. We’ll go through and look at the sheet and check off each of the measures that I would like to administer so that I don’t forget to administer anything.
I don’t know how many of you have also been in this situation where you wrap up an evaluation, send a client out the door, and then realize that you forgot to do that one thing that you really wanted to do. That’s happened to me a number of times over the years. So, selecting which tests you want to give, literally checking them off of a battery selection sheet I think can be helpful.
Now you could get into a lot of detail around, say a report writing checklist with each of the sections of the report. You can build a checklist for [00:22:00] the macro testing process like, do the intake, do the testing appointment, do the feedback appointment, write the report, send the report, that’s a checklist. So you can get as detailed as you would like and create as many checklists as you want, but we need to have some kind of checklist or process around the testing process itself.
And then, like I said, the report proofreading checklist was really a big one that has been super helpful. And this has a number of items on it just from doing an actual proofread. So, reading through the report a couple of times to make sure there are no errors, running spellcheck- my goodness. I can’t count how many reports I’ve almost sent out because I forgot to just run spell-check, replacing the name [00:23:00] placeholders, making sure you’ve got the right birthdate, making sure you have parents’ names correct or family members’ names correct, referral source.
There were a number of things on this checklist, but the crucial thing with any checklist that you put together is that you actually follow it. So you have to make this top of mind and easy to tune into when you need it. And the best way that I’ve found to do that is to use task management software to keep track, so have the checklist built right in and can help. It’s like you have to look through each of those items and in this read-do approach, you read the item, you do it, and then you check it out. And you don’t allow yourself to move forward until you’ve done that.[00:24:00] So checklists have been helpful on our practice. I continue to look for areas where we can put checklists in place.
Another area that is not testing specific but is helpful in a group practice is hiring. The hiring checklist is really helpful. There are any number of areas you could look at and devise checklists in your practice. And I hope that this is got you thinking about some areas that you could systematize a little bit more. Think about the places where you are most prone to making mistakes. Those are likely the best places to start in terms of building your checklists.
Now, I did not do this book nearly enough service. It’s really fascinating. It’s chock-full of real stories from the operating [00:25:00] room. If you like to geek out on statistics and research, it’s a good one for that. He dives deep into the impact of checklists on things like the length of client stay in the ICU, mortality rate, recovery rate. It’s really fascinating if you have any interest in the medical context.
I think there are a lot of principles that we can pull from the book and implement in our own practices. So hopefully this has got you thinking about where you might want to implement a checklist or two. And, of course, check out the book for more detail on that.
Thank you as always for listening to the clinical and business episodes here each week. I hope that you are enjoying the oncoming summer. I think this is going to be released close to summer. So, I hope that is going well [00:26:00] for you. Hope you’re feeling good, feeling hopeful, and maybe have some time away planned for the summer.
All right. If you have any need for CE credits, you can check out The Testing Psychologist podcast at athealth.com and you can find most of the clinical episodes available there for CE credits. So, check those out and take care.
I’m loving doing the podcast. I’m just so thankful for everybody who’s listening and keeps spreading the word to grow the listenership of the podcast. It’s really pretty amazing. So y’all, have a great week. I will be back with you on Monday with another clinical episode. Take care in the meantime.[00:27:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. [00:28:00] Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your needs.