Ready, check, go!

The long summer days are beginning to fade, and while we have high hopes for September sun there’s no denying that Autumn is almost upon us. To me though, there’s comfort to be found in the rhythm of the seasons and the ‘back to school’ feeling of September – whatever your age!

It’s not surprising that many of us associate routine and comfort with feeling safe. What is surprising is that until recently medical operations were not subject to routine, and there were many negative consequences as a result. In June 2008 the World Health Organization (WHO) launched the surgical safety checklist. It is: 'a simple tool designed to improve communication and teamwork by bringing together the surgeons, anaesthesia providers and nurses involved in care to confirm that critical safety measures are performed before, during and after an operation'.

The American surgeon Atul Gawande explains in his TED talk how his team were asked to look into why the mortality rate was so high in surgical operations. He recognised that surgeons were expertly skilled and brilliantly trained so the usual solution of introducing more training was not appropriate. So what could be?


He looked at other highly skilled professions for ideas and came across an unusual improvement; the introduction of a checklist for pilots. It was devised after a test flight in 1935 went wrong, and two pilots died in the resulting crash. Afterwards engineers were shocked to realise there had been no mechanical error – the pilots, operating a cutting edge new system, had made a mistake despite both being very experienced. As a result, management introduced the pre-flight checklist, and there were no more accidents in that model due to human error.

Gawande makes a distinction between errors of ignorance (mistakes we make because we don’t know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). He comes to the conclusion that experts need checklists - written guidelines that walk them through the key steps in any complex procedure. His research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success.

Between October 2007 and September 2008, the effect of the checklist was studied in eight hospitals in eight cities across the world. Researchers found the use of the checklist reduced the rate of deaths and surgical complications by more than one-third across all eight pilot hospitals.

Further improvements include cost savings and better communication between staff members, and similar checklists are now also in use in a range of other clinical areas, including childbirth, emergency departments, and intensive care units.

As you detect the first signs of Autumn, perhaps now is a good time to think about checklists and routine. You most likely have everyday tasks or moments in which you need to remember a set of steps or list of items. It may seem unnecessary or simplistic, but how much weight would a checklist take off your shoulders? Sometimes the simplest solutions are the most effective.