Surgeons and Checklists

Checklists in the fields of aviation, engineering, and other high reliability organizations have a long history, and have been shown to increase safety and aid human memory, among other benefits. More recently, checklists are being used in surgery to help the operating team. Checklist use in surgery holds promise for further improving safety and reducing error. Yet, there is evidence that surgeons have been reluctant to accept checklists, and hospitals have not embraced checklists as robust tools, even as they comply with basic standards set by the WHO and other governing bodies. In order to better understand the current use of checklists in surgery settings, the adoption of surgical checklists was investigated. This qualitative study explored the organizational and professional issues that influence surgeons’ adoption of checklists. Data was collected through qualitative interviews with nine surgeons, and eleven hospital administrators, as well as nine surgical observations. Data was analyzed using thematic analysis. Using data from multiple sources helped me to better understand the surgical checklist adoption process. All the surgeons interviewed complied with the use of surgical checklists. Most of the surgeons find the checklists useful, although some have customized the checklists. Some find the checklists useless: another bureaucratic hurdle that interferes with the art of medicine. The administrators expressed frustration at dealing with surgeons who do not want to use checklists. They often had to resort to asserting authority to gain compliance from surgeons. All the surgical teams complied with the use of checklists during the observations. Although the data indicates that checklists have been adopted in surgical settings, there is indication that the checklists are not used as robust tools. Compliance may indicate adoption, but the adoption of checklists in surgery appears to be rote; the checklists are not customized to different surgical specialties, and are not evolving over time as more is learned. Keywords: checklists, surgeons, safety, leadership, organizational culture, aviatio