Though Gawande admits he didn't expect to see the checklist make much difference in his own surgeries, he followed it to avoid hypocrisy and was surprised by the results. The checklist saved a life in at least one case, where a mistake by Gawande led to a critical need for blood while the mistake was corrected. Thanks to the checklist, extra blood had been prepared ahead of time, despite Gawande's confidence in performing a surgery he'd done successfully many times before.
If you do not want to exhaust your team members’ creativity, checklists are a must-have tool for production. Their function is simple - to check whether anything is forgotten or unfinished. And the most important thing is that you do not have to create a new checklist every time a task appears. Creative energy can be channeled to the more exacting tasks.
Concerns have recently been fuelled by the disappointing results after implementation of the checklist in Michigan17 and large-scale mandated implementation in Ontario Canada.5 Interpretations of results are also complicated by reported differences between perceived and actual application of the checklist. In a recent US study, hospital documentation indicated 100% compliance with checklists, but observers found that on average only 4 of 13 checklist items were actually completed.18 Even strong advocates for checklists admit that full implementation of the WHO checklist is difficult and that improvements require more than the checklist, including strong institutional leadership, data collection, and monitoring, and training in teamwork.4 ,14

‘Normal’ checklists are effective whenever there are advantages to standardising performance, time is not critical, the series of tasks is too long to be committed to memory (or there are likely to be interruptions to execution of the task that might interfere with memory retrieval), and the environment enables a physical list to be accessed and used.


Checklists are an effective way to get things accomplished but they can also create problems. Your success depends on the length of the checklist and your personality. Lists might help one person feel more organized, while others will feel overwhelmed or frustrated. Some people enjoy the tangible aspects of creating a list, while others ignore the list once it is created and focus on their thoughts instead. The key to effectively using a checklist is creating a list method that works for you.
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Gawande in 2009 introduced a hospital surgery checklist for doctors and nurses as part of a program developed with the World Health Organization. The checklist was designed to ensure basic checks were always completed before surgery. Run through the list, and you'll make sure everyone in on the same page about the surgery to be conducted, aware of who else was on the surgical team, and knows their role in the procedure.
Lastly, the checklist involves a Time Out: this requires that everything stops and no one interrupts. In an emergency, or under extreme time pressure, it is difficult to get everyone on the team to stop what they are doing and attend completely. The loss of team discussion under time pressure has been described by some centres implementing the Safe Surgery checklist.6 ,13 These are the times when mistakes are most likely to occur, yet paradoxically also when the Time Out portion of the checklist (the briefing to support complex work) is least likely to be performed as intended.
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