Intended for healthcare professionals


Practical challenges of introducing WHO surgical checklist: UK pilot experience

BMJ 2010; 340 doi: (Published 13 January 2010) Cite this as: BMJ 2010;340:b5433
  1. A Vats, clinical research fellow,
  2. C A Vincent, director of clinical safety research unit,
  3. K Nagpal, clinical research fellow,
  4. R W Davies, head of strategic development,
  5. A Darzi, head, division of surgery,
  6. K Moorthy, senior lecturer
  1. 1Department of Academic Surgery, Imperial College, St Mary’s Hospital Campus, London W2 1NY
  1. Correspondence to: A Vats amit.vats{at}
  • Accepted 22 November 2009

The WHO checklist has the potential to reduce preventable adverse events in surgery. But A Vats and colleagues’ experience suggests that a careful and rigorous implementation plan is required to ensure that the checklist is used routinely and correctly

As part of an initiative to improve patient safety the World Health Organization has developed a surgical checklist to ensure basic minimum safety standards.1 The National Patient Safety Agency has made it mandatory for all NHS trusts in England and Wales to implement an adapted version of the checklist by February.2 Use of the checklist will require a change in culture for operating theatre teams, and the benefits will be realised only if everyone is supportive of the change and implementation is robust. Our experience in piloting the NHS checklist highlights some of the potential challenges and barriers.

Implementation process

Two operating theatres at our hospital were selected to pilot the new checklist (figure). The theatres were selected to represent the bulk of surgery done in the NHS, one being used for trauma and orthopaedic surgery and the other for gastrointestinal surgery and gynaecological procedures. After collecting data on current practice, we devised a comprehensive implementation strategy. The research team met operating theatre staff individually, in small groups, and through a wider hospital forum. We proposed that the checklist process should be led by nurses to flatten hierarchy and support shared teamwork. In the first two weeks of the implementation, a member of the research team was present in the theatres to train operating teams in use of the checklist, encourage use, and answer any queries.

WHO checklist for England and Wales2

Initial reactions

On the whole, anaesthetists and nurses were largely supportive of the checklist. Some consultant surgeons were not very enthusiastic, but by using local surgical champions to …

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