Checklists in Action
The Power of Checklists in Healthcare and Beyond
Complex Systems Need Layered Protection
Introduction
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. 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.
HISTORY
The Making
of the Checklist
The Making of the Checklist
1960
2001
2003 - 2006
2007 - 2008
2009
1960
2001
2003 - 2006
2007 - 2008
2009
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
1960
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
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
2001
Peter Pronovost’s 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
2003-2006
The Michigan Keystone ICU Project
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
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 Saves 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
2007-2008
Safe Surgery Saves Lives
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
Safe Surgery Saves 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
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
2009
The Official 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
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
NUMBERS
The Effects of Checklist Around the World
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
50%
A reduction in mortality was observed across the eight hospitals during the WHO's initial research.¹⁰
Since the WHO introduced its Surgical Safety Checklist, research on its impact has grown rapidly. Studies show it improves patient safety, operating room efficiency, and team communication—benefits achievable in hospitals of any size or budget. Today, the checklist is a cornerstone of surgical safety, driving safer, more reliable care worldwide.
STUDIES
STUDIES
Surgical Safety Checklist Benefits
Surgical Safety
Checklist Benefits
Global studies on efficacy of the Surgical Safety Checklist
Decreases Infections
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
Drops Morbidity Rates
In a 2012 comparative study at the University of Connecticut’s Department of Surgery, a checklist was introduced for high-risk procedures through three 60-minute team training sessions. With a 97.26% completion rate, checklist use was associated with a marked reduction in 30-day morbidity, from 23.60% to 8.20% compared with historical controls. The study demonstrated that combining a comprehensive checklist with team training can significantly improve patient outcomes and surgical safety.
Shortens Hospital Stays
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
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
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
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
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
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
Flexible to Surgical Contexts
Flexible to 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
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
INDUSTRIES
Checklists in Other Industries
From aviation to finance, checklists enhance safety and compliance. See when they saved lives and when ignoring them proved costly.
INDUSTRIES
Checklists in Other Industries
From aviation to finance, checklists enhance safety and compliance. See when they saved lives and when ignoring them proved costly.
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
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
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 Memeber
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
AEROSPACE
The Fourth Crew Memeber
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
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 POWER
The Worst Nuclear Disaster
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
Roadblocks in Implementation and Adherence
Lorem ipsum dolor sit amet ignis aurum probat primum non nocere aurum probatium wingardium leviosa expecto patronum.
Cultural Challenges
In the operating room, advocates of checklists encounter resistance to change, lack of prioritization, poor team communication, and deep-rooted hierarchical structures, all of which can significantly diminish the efficacy of checklists.
The Black Box Platform™ Solution
The OR Black Box facilitates team communication by enabling practitioners to assess their team's performance within a non-punitive environment. Fostering a culture of open communication and feedback can promote buy-in and acceptance.
Cultural Challenges
In the operating room, advocates of checklists encounter resistance to change, lack of prioritization, poor team communication, and deep-rooted hierarchical structures, all of which can significantly diminish the efficacy of checklists.
The Black Box Platform™ Solution
The OR Black Box facilitates team communication by enabling practitioners to assess their team's performance within a non-punitive environment. Fostering a culture of open communication and feedback can promote buy-in and acceptance.
Cultural Challenges
In the operating room, advocates of checklists encounter resistance to change, lack of prioritization, poor team communication, and deep-rooted hierarchical structures, all of which can significantly diminish the efficacy of checklists.
The Black Box Platform™ Solution
The OR Black Box facilitates team communication by enabling practitioners to assess their team's performance within a non-punitive environment. Fostering a culture of open communication and feedback can promote buy-in and acceptance.
Efficiency Challenges
Checklists can inadvertently introduce efficiency hurdles. The additional workload associated with them must be managed effectively to prevent employee burnout and maintain a balance between high-quality care delivery and efficiency.
The Black Box Platform™ Solution
The OR Black Box optimizes workflow by customizing checklists to meet the specific needs of each hospital. It regularly monitors their efficacy without imposing additional workload on hospital staff.
Efficiency Challenges
Checklists can inadvertently introduce efficiency hurdles. The additional workload associated with them must be managed effectively to prevent employee burnout and maintain a balance between high-quality care delivery and efficiency.
The Black Box Platform™ Solution
The OR Black Box optimizes workflow by customizing checklists to meet the specific needs of each hospital. It regularly monitors their efficacy without imposing additional workload on hospital staff.
Efficiency Challenges
Checklists can inadvertently introduce efficiency hurdles. The additional workload associated with them must be managed effectively to prevent employee burnout and maintain a balance between high-quality care delivery and efficiency.
The Black Box Platform™ Solution
The OR Black Box optimizes workflow by customizing checklists to meet the specific needs of each hospital. It regularly monitors their efficacy without imposing additional workload on hospital staff.
Execution Challenges
Insufficient training, lack of ownership, and unclear expectations lead to shortcuts and a checkbox mentality, rather than fostering a shared, collaborative mental model of the procedure. This undermines the effectiveness and purpose of the checklist.
The Black Box Platform™ Solution
The OR Black Box implements a checklist adaptable to diverse settings, following universal standards. This approach ensures that clear expectations for improvement are known and measured, promoting the use of checklists as collaborative tools.
Execution Challenges
Insufficient training, lack of ownership, and unclear expectations lead to shortcuts and a checkbox mentality, rather than fostering a shared, collaborative mental model of the procedure. This undermines the effectiveness and purpose of the checklist.
The Black Box Platform™ Solution
The OR Black Box implements a checklist adaptable to diverse settings, following universal standards. This approach ensures that clear expectations for improvement are known and measured, promoting the use of checklists as collaborative tools.
Execution Challenges
Insufficient training, lack of ownership, and unclear expectations lead to shortcuts and a checkbox mentality, rather than fostering a shared, collaborative mental model of the procedure. This undermines the effectiveness and purpose of the checklist.
The Black Box Platform™ Solution
The OR Black Box implements a checklist adaptable to diverse settings, following universal standards. This approach ensures that clear expectations for improvement are known and measured, promoting the use of checklists as collaborative tools.
Measurement Challenges
Maintaining quality and compliance standards presents a challenge when audits are infrequent, poorly executed, short-lived, and reluctant to incorporate feedback aimed at enhancing the checklist's execution.
The Black Box Platform™ Solution
The OR Black Box conducts regular audits to assess its adherence and effectiveness, serving as a centralized hub. It establishes a clear communication channel and feedback mechanism to address measurement and scalability challenges as they arise.
Measurement Challenges
Maintaining quality and compliance standards presents a challenge when audits are infrequent, poorly executed, short-lived, and reluctant to incorporate feedback aimed at enhancing the checklist's execution.
The Black Box Platform™ Solution
The OR Black Box conducts regular audits to assess its adherence and effectiveness, serving as a centralized hub. It establishes a clear communication channel and feedback mechanism to address measurement and scalability challenges as they arise.
Measurement Challenges
Maintaining quality and compliance standards presents a challenge when audits are infrequent, poorly executed, short-lived, and reluctant to incorporate feedback aimed at enhancing the checklist's execution.
The Black Box Platform™ Solution
The OR Black Box conducts regular audits to assess its adherence and effectiveness, serving as a centralized hub. It establishes a clear communication channel and feedback mechanism to address measurement and scalability challenges as they arise.
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
Lead with Truth, Improve with Insight
Lead with Truth,
Improve with Insight
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
© 2026 Surgical Safety Technologies, Inc. All Rights Reserved.
© 2026 Surgical Safety Technologies, Inc.
All Rights Reserved.
© 2026 Surgical Safety Technologies, Inc. All Rights Reserved.