The checklist effect
In 1935 two experienced test pilots were killed when the Boeing prototype bomber crashed during a demonstration flight. Test pilots went on to create a checklist that standardized the procedures required to safely operate what later became known as the B-17 bomber.
In medicine, as in aviation, checklists can help ensure consistency and completeness in carrying out complex tasks.
The WHO Surgical Safety Checklist
Under the expert lead of Professor Atul Gawande at the Harvard School of Public Health, WHO Patient Safety has taken the concepts and principles of the aviation checklist and applied them to surgery. The results of a year-long pilot study of the Surgical Safety checklist in eight developed and developing countries were published in January 2009, in the New England Journal of Medicine. This study revealed an overall significant reduction in mortality and morbidity after implementation of the checklist. With the success of the WHO Surgical Safety Checklist, among other medical checklists, it is feasible to imagine that many more processes of care could be amenable to such a safety measure.
WHO Patient Safety is currently developing a framework for identifying a range of clinical care processes where checklists would lead to an improvement in patient safety and clinical outcomes. With the help of other collaborating departments within WHO, we are already developing pilot checklists in a range of disciplines, including labour & delivery, neonatal care, and trauma care.
The WHO Surgical Safety checklist and other checklists have improved reliability and helped to standardize care for thousands of patients globally. Checklists allow complex pathways of care to function with high reliability by giving users the opportunity to pause and take stock of their actions ensuring that nothing has been omitted before proceeding to the next step. The checklist approach has the same potential to save lives and prevent morbidity in medicine that it did in aviation over 70 years ago by ensuring that simple standards are applied for every patient, every time.