title: Double checking: a second look.
abstract: OBJECTIVE
  Double checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: 'How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?'
  
  
  METHODS
  This is part of a larger qualitative study based on 85 semi-structured interviews of health care practitioners in general internal medicine and obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported.
  
  
  RESULTS
  Weaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time-consuming procedure, double checking trusted as an accepted and stand-alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in-family approach, and resilience.
  
  
  CONCLUSIONS
  Double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged.
authors.affiliation: Population Health, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tanya
authors.identifier: http://orcid.org/0000-0002-0379-6548
authors.initials: T
authors.lastname: Hewitt
authors.affiliation: Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Samia
authors.initials: S
authors.lastname: Chreim
authors.affiliation: Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Forster
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D017751:Safety Management / Q000379:methods*
keywords: medical errors; medication errors; nursing; patient safety; quality assurance health care; safety management