We need a safety system (and an operations manual)BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c917 (Published 23 February 2010) Cite this as: BMJ 2010;340:c917
All rapid responses
The checklists, developed by the World Health Organisation and the
National Patient Safety Association, and carried out before and after
operations, can save lives 1. However, the check lists are minimal sources
of information compared with the operations manuals needed in the safety
management systems of high reliability organisations 2. Pilots’ operations
manuals in the aviation industry are good examples 3. Mistakes could
easily be made with the checklists due to laxity or lack of information.
For instance, permitting a patient to describe her operation as
“gallstones” opens the door to error 4. Checking in a patient correctly
requires much information used with precision 5.
checklists cover neither the multitude of safety checks carried out during
the course of an operation, nor the backup information required to perform
For the health service to become a high reliability organisation, it
requires operations manuals, nowhere more so than in surgery 2,3. The
manuals would need to include the above checks and also all the other
operative steps, plus back up information. Examples of such manuals for
complex operations already exist, in the form of detailed scripts on
Wikisurgery.com, the free online surgical encyclopaedia 6.
The scripts have a structure that could be used to help make manuals for
any surgical operation. After being edited online, the scripts now contain
the WHO checklists modified for England and Wales, as well as information
on how to perform them safely.
Operations manuals on the lines of surgical scripts, within appropriate
safety management systems, could help transform the health service into a
high reliability organisation.
1 Taylor B, Slater A, Reznick R. The surgical safety checklist effects are
sustained, and team culture is strengthened. Surgeon 2010 Feb;8(1):1-4.
2 Vincent C, Benn J, Hanna GB. High Reliability in Healthcare. BMJ
3 Toff NJ. We need a safety system. BMJ 2010;340:c917.
4 Patient safety videos.
5 Patient checks.
6 Knox R Edwards M. Aortic aneurysm graft.
We are editors pf Wikisurgery
Competing interests: No competing interests