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History

Impact

Across Industries

Challenges



Checklists



In Action

The Power of Checklists In Healthcare and Beyond

IN COMPLEX SYSTEMS, MULTIPLE DEFENCE LAYERS REDUCE THE IMPACT OF ERRORS.


NAVIGATING RISKS AND SAFETY LAYERS IN SURGERY

Imagine standing in the pouring rain, equipped with all the rain gear you can
think of—umbrella, hat, raincoat, and even shelter under a roof. Despite these
layers of protection, there are moments when the rain manages to find a way in,
perhaps due to a gust of wind or small openings in your gear. This situation is
analogous to what James Reason termed the Swiss Cheese Model, illustrating that
even with multiple safety measures, vulnerabilities can align, leading to
mistakes.¹²

In critical environments like hospitals, where safety is paramount, the Swiss
Cheese Model is utilized to comprehend and prevent errors. One specific tool
derived from this understanding is the Surgical Safety Checklist—a tool designed
to prevent errors and ensure a high level of safety. It's akin to systematically
addressing potential holes in the Swiss cheese to create a more secure and
reliable system.


THE MAKING
OF THE CHECKLIST

THE NURSES' CHECKLIST

Nurses developed patient charts and forms that incorporated the monitoring of
four vital signs: body temperature, pulse, blood pressure, and respiratory rate.
These tools enabled them to track their patients' health status by regularly
checking and evaluating vital signs every six hours. This system helped ensure
that patients received timely and appropriate medical attention when necessary.⁵




PETER PRONOVOST'S CHECKLIST

Critical care specialist Peter Pronovost introduced a checklist system at Johns
Hopkins Hospital's ICU. The system included five simple steps that nurses could
use to observe doctors and stop them if they skipped a step. This collaborative
approach allowed for effective communication between medical professionals and
resulted in a remarkable outcome. Within a year, infections dropped from 11% to
0%, preventing 43 infections and eight deaths and saving the hospital $2 million
in costs.⁵



THE MICHIGAN KEYSTONE ICU PROJECT

The Keystone Initiative in Michigan utilized a checklist system to enhance
patient safety in ICUs. Each participating hospital rolled out the checklist and
observed the results with Peter Pronovost's supervision. Within three months,
the infection rate in Michigan's ICUs dropped by 66%, saving more than 1,500
lives and reducing costs by roughly $175 million.¹²



SAFE SURGERY SAFE LIVES

To enhance patient safety and implement safer surgical procedures, a global
research team led by Atul Gawande launched a project aimed at reducing adverse
events in both operating rooms and wards. The team selected eight hospitals
worldwide. This initiative reflects the importance of a global approach to
patient safety, utilizing evidence-based practices and collaboration to improve
outcomes in healthcare settings worldwide.⁹



🌐 NEWS!

2009

50%

A reduction in mortality was observed across the eight hospitals during the
WHO's initial research.¹⁰

THE OFFICIAL CHECKLIST

After extensive research spanning several years, the World Health Organization
developed a surgical safety checklist in 2009 that healthcare workers worldwide
use in their operating rooms today. This standardized and universal checklist
has become an essential tool for ensuring patient safety during surgical
procedures, reflecting the WHO's commitment to improving healthcare outcomes
globally.¹⁰



🇺🇸 NEWS!

2010

22%

A relative reduction in postoperative mortality was observed after the
implementation of the Checklist in South Carolina.¹⁰

🇮🇷 NEWS!

2011

57%

A reduction in surgical complications was observed in a 374-bed hospital after
using the Checklist in Iran.¹⁰

🏴󠁧󠁢󠁳󠁣󠁴󠁿 NEWS!

2019

36%

A reduction in post-surgical deaths was observed since the introduction of the
Checklist in Scotland.¹⁰

WORLDWIDE IMPACT

As of 2019, the WHO's checklist is utilized in 70% of operating rooms worldwide,
with over 20 countries adopting it as their national standard.¹⁰



FROM PAST MILESTONES TO FUTURE INNOVATIONS


THE POST-IMPLEMENTATION BOOM IN RESEARCH

The academic research on surgical checklists has surged significantly since the
World Health Organization (WHO) endorsed its own checklist. Surgeons and
researchers consistently unveil new insights to enhance patient safety,
operating room efficiency, and team communication with the goal of improving
patient safety in any hospital, regardless of size or budget.

The journey continues, and the Checklist has become a fundamental aspect of
safety protocols in surgery, ensuring that patient safety remains a top priority
and pushing for safer and more efficient healthcare practices globally.



HOW DOES THE CHECKLIST IMPROVE PATIENT SAFETY?




DECREASES INFECTIONS

In 2021, a study in Brazil concluded that the implementation of the surgical
checklist in 2010 reduced surgical site infections (SSI), particularly in
contaminated and infected wounds.³ According to their findings, the checklist
also lowered infections caused by hard-to-treat microorganisms, decreased
antimicrobial resistance, and led to a 3.2% drop in in-hospital mortality. The
use of the checklist demonstrated a positive impact on patient safety and
outcomes.



DROPS MORBIDITY RATES

In a 2012 comparative study at the Department of Surgery at the University of
Connecticut, the checklist was introduced for high-risk procedures in three
60-minute team training sessions. With an impressive 97.26% completion rate,
cases utilizing the checklist saw a substantial drop in 30-day morbidity,
decreasing from 23.60% to 8.20% compared to historical controls. This study
underscored that the integration of a comprehensive checklist, alongside team
training, profoundly enhances patient outcomes, presenting a feasible and
impactful strategy for elevating surgical safety.¹

SHORTENS HOSPITAL STAYS

In 2015, a randomized controlled trial conducted in Norway revealed that the use
of the WHO Surgical Safety Checklist (SSC) led to shorter hospital stays by
almost a day on average. It significantly lowered complications during hospital
stays, dropping from 19.9% to 11.5%. The checklist proved effective, reducing
the chances of issues (hence shorter stays) even when considering other
factors.⁶

IMPROVES TEAMWORK

In 2023, a qualitative study conducted in Switzerland revealed positive impacts
on leadership, teamwork, timing, and acceptance with the use of the WHO Surgical
Safety Checklist. Challenges, including understanding and training gaps,
resulted in execution variations despite effective implementation. Improvement
in teamwork and communication occurred, but hurdles influenced overall
effectiveness.¹³



ENHANCES SAFETY CULTURE

In 2012, a 20-study review conducted in Germany underscored the powerful impact
of the Surgical Safety Checklist, revealing up to a 62% reduction in
perioperative mortality and a 37% drop in morbidity. The study concluded that
the checklist serves as a crucial instrument for enhancing communication,
teamwork, and safety culture in the operating room.⁴



ADAPTS TO VARIOUS SURGICAL CONTEXTS

In a 2015 study conducted in India involving 700 surgery patients, those using a
modified WHO Surgical Safety Checklist (Rc Arm) demonstrated significant
improvements, with lower rates of complications such as wounds, abdominal
issues, and bleeding. The study emphasized that the surgical safety checklist is
not a rigid manual but a dynamic aid, adapting to various surgical contexts to
enhance patient safety.²





CHECKLISTS IN
OTHER INDUSTRIES



-AVIATION-

THE MIRACLE ON THE HUDSON

In 2009, US Airways Flight 1549 struck a flock of geese after take-off,
resulting in a complete loss of engine power. Captain Sullenberger and First
Officer Skiles skillfully landed the plane in the Hudson River, ensuring the
survival of all 155 people on board. The pilots' adherence to checklists,
communication, and mutual support played a critical role, highlighting the
significance of discipline and teamwork in aviation safety.⁵





-AEROSPACE-

THE FOURTH CREW MEMBER

Checklists played a crucial role in the Apollo 11 mission. From operating
onboard computers to spacesuit procedures, every corner of the Apollo
environment had a checklist. Even outside the spacecraft, astronauts relied
heavily on checklists, with cuff checklists attached to their wrists. These
checklists were so significant that Michael Collins referred to them as "The
Fourth Crew Member," highlighting their importance in the mission's success.⁷





-CONSTRUCTION-

A DEADLY DANCE NIGHT

In 1981, during a dance event at the Hyatt Regency Hotel in Kansas City, two
suspended walkways collapsed, resulting in 114 fatalities and 216 injuries. The
accident was caused by last-minute engineering changes, approved without
thorough review and calculations. This event underscored the importance of
effective communication, documentation, and checklists in preventing accidents.⁸






-NUCLEAR-

THE WORST NUCLEAR DISASTER

In 1986, the Chernobyl disaster resulted from a reactor shutdown gone wrong,
leading to explosions, fires, and the release of radioactive materials. The
accident exposed a weak safety culture, a lack of communication among
stakeholders, coupled with strict hierarchies. The implementation of a checklist
might have clarified procedures and ensured that key safety protocols were
followed during routine operations and emergencies.¹¹





CHALLENGES IMPLEMENTING THE CHECKLIST





CULTURE

In the operating room, healthcare providers frequently encounter challenges
associated with hierarchy, posing a substantial obstacle to the successful
implementation of checklists. Fear of speaking up, intimidation, and deeply
rooted cultural biases can undermine the effectiveness of the Checklist.

The OR Black Box® Impact

The OR Black Box facilitates team communication by providing practitioners with
the ability to evaluate their team's performance and compliance within a
non-punitive environment.




COMPLIANCE

Monitoring and ensuring compliance in the operating room presents just one of
the numerous challenges healthcare practitioners encounter daily. Common issues
such as work overload, miscommunication, workflow disruptions, and inadequate
support often contribute to accidents and errors. Additionally, measuring
compliance proves challenging due to limited audit accessibility, thereby
complicating the evaluation of quality standards.

The OR Black Box® Impact

The OR Black Box leverages cutting-edge technologies to monitor compliance with
safety protocols omnipresently, enabling hospitals to track performance
non-punitively and improve based on data-driven insights.


SCALABILITY

The implementation of the Checklist presents numerous challenges that demand
collaborative efforts across all healthcare levels. Continuous monitoring
becomes challenging for healthcare practitioners, given the pressures of the
workplace and the need for efficiency.

The OR Black Box® Impact

The OR Black Box revolutionizes surgical safety with automated video processing
on a large scale, a stride beyond manual methods. It captures real-time data,
optimizing workflows, enhancing checklist implementation by providing feedback,
and fostering continuous improvement.




THE SURGICAL SAFETY CHECKLIST IS NOT A CURE-ALL SOLUTION

Checklists serve as invaluable aids across diverse sectors such as aviation,
medicine, and engineering, facilitating the adherence to critical steps and
efficient communication of vital information. However, the efficacy of a
checklist hinges on its design, implementation, and the specific operational
context.

Ultimately, the purpose of a checklist transcends rigid adherence; rather, it
serves to align the team and cultivate a collaborative environment.
Organizations and hospitals bear the responsibility of fostering meticulous
teamwork through the utilization of checklists.




THERE IS A SOLUTION FOR SAFER SURGERY



LEARN MORE


REFERENCES

¹ BLISS, L. A., ROSS-RICHARDSON, C. B., SANZARI, L. J., SHAPIRO, D. S.,
LUKIANOFF, A. E., BERNSTEIN, B. A., & ELLNER, S. J. (2012). THIRTY-DAY OUTCOMES
SUPPORT IMPLEMENTATION OF A SURGICAL SAFETY CHECKLIST. JOURNAL OF THE AMERICAN
COLLEGE OF SURGEONS, 215(6), 766–776.
HTTPS://DOI.ORG/10.1016/J.JAMCOLLSURG.2012.07.015 

² CHAUDHARY, N., VARMA, V., KAPOOR, S., MEHTA, N., KUMARAN, V., & NUNDY, S.
(2015). IMPLEMENTATION OF A SURGICAL SAFETY CHECKLIST AND POSTOPERATIVE
OUTCOMES: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY. JOURNAL OF GASTROINTESTINAL
SURGERY : OFFICIAL JOURNAL OF THE SOCIETY FOR SURGERY OF THE ALIMENTARY
TRACT, 19(5), 935–942. HTTPS://DOI.ORG/10.1007/S11605-015-2772-9

³ DE ALMEIDA, S. M., DE MENEZES, F. G., MARTINO, M. D. V., TACHIRA, C. R.,
TONIOLO, A. D. R., FUKUMOTO, H. L., EDMOND, M. B., & MARRA, A. R. (2021). IMPACT
OF A SURGICAL SAFETY CHECKLIST ON SURGICAL SITE INFECTIONS, ANTIMICROBIAL
RESISTANCE, ANTIMICROBIAL CONSUMPTION, COSTS AND MORTALITY. THE JOURNAL OF
HOSPITAL INFECTION, 116, 10–15. HTTPS://DOI.ORG/10.1016/J.JHIN.2021.05.003

 ⁴ FUDICKAR, A., HÖRLE, K., WILTFANG, J., & BEIN, B. (2012). THE EFFECT OF THE
WHO SURGICAL SAFETY CHECKLIST ON COMPLICATION RATE AND COMMUNICATION. DEUTSCHES
ARZTEBLATT INTERNATIONAL, 109(42), 695–701.
HTTPS://DOI.ORG/10.3238/ARZTEBL.2012.0695

⁵ GAWANDE, A. (2010). THE CHECKLIST MANIFESTO. : PROFILE BOOKS LTD.

⁶ HAUGEN, A., SØFTELAND, E., ALMELAND, S., SEVDALIS, N., VONEN, B., EIDE, G.,
NORTVEDT, M., HARTHUG, S. EFFECT OF THE WORLD HEALTH ORGANIZATION CHECKLIST ON
PATIENT OUTCOMES: A STEPPED WEDGE CLUSTER RANDOMIZED CONTROLLED TRIAL. ANNALS OF
SURGERY 261(5):P 821-828, MAY 2015. | DOI: 10.1097/SLA.0000000000000716

⁷ HERSCH, M. (2009, JULY 19). THE FOURTH CREWMEMBER. SMITHSONIAN MAGAZINE.
HTTPS://WWW.SMITHSONIANMAG.COM/AIR-SPACE-MAGAZINE/THE-FOURTH-CREWMEMBER-37046329/ 

⁸ HYATT REGENCY WALKWAY COLLAPSE. (N.D.). ONLINE ETHICS CENTER.
HTTPS://ONLINEETHICS.ORG/PRINT/PDF/NODE/44241

⁹ KIRBY, T. (2010, SEPTEMBER 25). ATUL GAWANDE—MAKING SURGERY SAFER WORLDWIDE
[EDITORIAL]. PERSPECTIVES, 376(9746), 1045.
HTTPS://DOI.ORG/HTTPS://DOI.ORG/10.1016/S0140-6736(10)61473-0

¹⁰ LIFEBOX, ARIADNE LABS. (2020, JANUARY 15). CHECKING IN ON THE CHECKLIST.
LIFEBOX. RETRIEVED FEBRUARY 27, 2024, FROM
HTTPS://WWW.LIFEBOX.ORG/CHECKINGINONTHECHECKLIST/ 

¹¹ MOLLER, N., HANSSON, S., HOLMBERG, J., ROLLENHAGEN, C. (EDS.). (2017).
HANDBOOK OF SAFETY PRINCIPLES. : JOHN WILEY & SONS INC..
HTTPS://DOI.ORG/10.1002/9781119443070.CH28

¹² REASON J. (2000). HUMAN ERROR: MODELS AND MANAGEMENT. BMJ (CLINICAL RESEARCH
ED.), 320(7237), 768–770. HTTPS://DOI.ORG/10.1136/BMJ.320.7237.768

¹³ WYSS, M., KOLBE, M., & GRANDE, B. (2023). MAKE A DIFFERENCE: IMPLEMENTATION,
QUALITY AND EFFECTIVENESS OF THE WHO SURGICAL SAFETY CHECKLIST-A NARRATIVE
REVIEW. JOURNAL OF THORACIC DISEASE, 15(10), 5723–5735.
HTTPS://DOI.ORG/10.21037/JTD-22-1807