WHO’s surgical safety checklist: it ain’t what you do . . .

This year marks the 10th anniversary of the UK’s adoption of the World Health Organization’s surgical safety checklist.1 The logic of using a checklist was borrowed from aviation—pilots use them to prevent avoidable crashes.2 WHO’s list contains 19 checks to be read aloud to the whole team, some at each of three stages of an operation—sign in, time out, and sign out.

In 2008, a WHO funded study in eight hospitals worldwide reported impressive results.3 Overall, surgical complications within 30 days of operating fell from 11% at baseline to 7% after the checklist was implemented, and in-hospital deaths fell from 1.5% to 0.8%.

But these figures don’t tell the whole story. “It’s not just whether it’s being done or not, but how well it’s being done,” Krishna Moorthy, honorary consultant surgeon at Imperial College London and a coauthor of the 2008 study, told a meeting at the Royal Society of …