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I just stole a process from a different profession to use in my remodeling company. I’ve used it myself for over 25 years, thousands of times. Every time I took off in the EMS helicopter, we call it our responsive takeoff checklist, I just didn’t see how it fit until I saw it being used in surgery recently. The caveat is that “Anyone can abort a flight”, “it takes three to go, and one to say no.” We have slowly incorporated it into all sorts of high-risk medical procedures we perform on a routine basis.

It is called a “procedural pause” in medicine and it has undoubtedly saved all sorts of mistakes from occurring. You probably knows someone who has suffered as a result of a medical error.

The idea is designed to STOP! and focus everyone on the high risk procedure that is about to take place. One person reads a bullet pointed checklist aloud with the total attention of the participants and there is a positive response at each bullet point or the process stops, until the checklist is complete. Right patient…name bracelet is read aloud, check. Right procedure, Check. For the right reason, check. On the right anatomical part, etcetera.

With patient safety being a buzzword on hospitals these days, I anticipate the numbers of mistakes to decrease dramatically!

Here is how it worked recently

We just used it for the first time when we pulled out and swapped a beam to enlarge an opening in a Bearing wall. Making the checklist was cathartic. The rationale was obvious. We have employees with all levels of experience who are working together to accomplish a dangerous / high-risk task.

With the entire crew assembled the Crew Leader read off the checklist to a focused crew. Questions were answered, contingencies were made and upon affirmation of the entire group, the beam was replaced successfully.

Who is watching over you?

It dawned on me that had we used this process when a scaffold was constructed improperly that it would have been caught and an accident avoided. OSHA has all sorts of rules and regulations that cover issues related to injuries and deaths attributed to high-risk operations at job sites. The problem is that like the Whack-a-mole game and book of the same name, high-risk behavior is only punished when you get caught, injured, or killed!

What’s next?



Let’s take a step as an industry of professionals and create a responsive checklist for every high risk procedure we do.  A procedural pause is a great way of team building as well, if you want to take it to the next level. Do a debrief after you’re done, get input from everyone involved to see if there is anything to learn to improve your processes from your teams experience.

As one of my old favorite TV shows, Hill Street Blues, Sergeant Phil Esterhaus says, “Hey, let’s be careful out there.”

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