Checklists: love them or hate them, they’re everywhere in healthcare. From operating rooms to home health, they help ensure nothing critical gets missed in the complex and high-stakes world of patient care.
But not all checklist use is created equal.
Some clinicians worry that relying on checklists turns their hard-earned expertise into “cookie-cutter medicine.” Others fall into the trap of blindly following checklists without considering the why behind the tasks. Both perspectives reveal a misunderstanding of what checklists are truly meant to do—and their real value in healthcare.
Let’s unpack these issues and reimagine how we can use checklists as tools to enhance, rather than hinder, our practice.
The “Cookie-Cutter Medicine” Concern
A common critique of checklists is that they strip away clinical judgment, reducing healthcare professionals to robots following a script. After all, if everything is dictated by a checklist, why even have educated professionals?
I’ve experienced this concern firsthand during my time working with a home health agency that adopted a rigid “critical pathways” framework. These pathways provided detailed instructions: how many visits each patient should receive, what each visit should cover, and even when services should conclude.
At first glance, it seemed like “cookbook medicine.” But there was an essential safeguard: clinical judgment.
For instance, if a patient recovering from a hip replacement still had complications by their final scheduled visit, I had the ability to deviate from the pathway. I documented the issues as “variances” and extended care as needed. The checklist served as a guide, not a substitute for critical thinking.
The takeaway: Checklists are not a replacement for your expertise. Instead, they’re a safety net—a tool to enhance patient safety and consistency while allowing room for your judgment and flexibility.
The Trap of Check-the-Box Thinking
On the other hand, some organizations fall into the trap of treating checklists as the end goal instead of a means to an end.
Take hospitals pursuing Magnet status as an example. To achieve this designation, institutions must implement practices like shared governance councils or nurse residency programs. The idea is that these initiatives improve workplace culture, retain staff, and ultimately, enhance patient outcomes.
But when hospitals implement these programs to merely “check the box” for Magnet criteria—without understanding or committing to their underlying purpose—the results fall flat.
I’ve seen shared governance councils that exist on paper but fail to give nurses a real voice. Leaders dismiss the program as ineffective, not realizing the flaw isn’t with the idea but with the execution.
The takeaway: A checklist is only as good as the thought and intention behind it. If we treat it as a box to tick rather than a meaningful guide, we risk losing its potential to drive positive change.
Reframing the Role of Checklists
Both of these pitfalls stem from a misunderstanding:
- The belief that the checklist is the boss.
- The assumption that the checklist has inherent power.
Here’s the truth: you are the boss of the checklist. It’s a tool, not a dictator. It’s a guide, not a guarantee.
When used thoughtfully, checklists can help us focus on what matters most, ensure consistency in complex processes, and support better outcomes. But it’s our responsibility to use them wisely—to pair them with critical thinking, clinical judgment, and a deep understanding of the why behind each item.
Your Turn
So, how do you view checklists in your practice?
- Are they a helpful tool or an unnecessary burden?
- Do you use them to guide your work or simply to check the box?
- How might you reframe your approach to make the most of this powerful tool?
Let’s start a conversation—drop your thoughts in the comments. Together, we can elevate the way we use checklists to improve care without compromising our professionalism or humanity.