You were on the team that developed the World Health Organization’s safety checklist that’s used in ORs around the world. Are you amazed by how the tool has developed into an essential part of pre-op routines?
Checklists weren’t new to medicine a decade ago when we published the first large systematic evaluation of the safety checklist in surgery, but it is remarkable how fast acceptance of the tool has spread and how widespread its use has become. I was a bit skeptical that we could make such a dramatic change in patient safety in such a short period of time. When we first developed and tested the checklist, I thought I’d be an old, retired surgeon before it was actually used in practice.

How can surgical teams improve application of the checklist?
Unfortunately, the checklist is often viewed as an audit tool, which staff and surgeons use to simply check off boxes before operating. It’s actually supposed to inspire and guide communication among members of the surgical team. It should empower them to speak up and share their common knowledge about the patient. They should discuss what’s expected to occur during surgery and where potential safety pitfalls might occur.

How do you anticipate the checklist evolving over the next 10 years?
One major piece revolves around staff training and recognizing that each individual plays an essential role on high-level surgical teams, which function most efficiently and effectively when all members share their knowledge and expectations of what should happen during surgery. Roles in the OR need to be clearly defined and the checklist provides a mechanism for guiding that process.

How should the checklist foster communication in the OR?
It’s a tool that gets surgical teams talking before procedures and focused on safe patient care. I’ve seen teams set the tone for constructive communication, especially those who work together frequently and don’t feel it’s necessary to constantly introduce themselves before each case, by sharing nice things that happened to them over the weekend or by recognizing a team member’s birthday.

What is the checklist’s essential element?
The blurb we included at the bottom: Additions and modifications to fit local practices are encouraged. We recognize the checklist can be difficult to complete and some steps need to be rearranged, depending on how surgical teams and anesthesia providers work in individual facilities. The checklist is at its best when it’s constantly reevaluated and reworked as surgery and surgical safety continue to evolve. OSM