Checklists, global health and surgery: a five-year checkup of the WHO Surgical Safety checklist programme

The WHO Surgical Safety Checklist has become a high-profile symbol for patient safety efforts in surgery. Since the landmark study by Haynes et al. 1 documenting its success at reducing peri-operative morbidity and mortality in a diversity of settings, others have gone on to show positive effects of the checklist on teamwork, communication, and patient outcomes. The widespread dissemination of the checklist has now allowed for a more global analysis of its role in surgery, and has highlighted two key points: first, the success of the checklist relies on effective and appropriate implementation; and second, the checklist needs to be introduced as part of a broader patient safety movement. Beyond universal challenges with implementation, some questions have been asked about its applicability to low- and middle-income countries. WHO acknowledges that checklist implementation in such settings needs to be well considered; limited availability of resources and less structure around patient safety provides a different context for effective use. Further research needs to be undertaken to better understand what if any modifications need to be made. WHO also hope to better coordinate patient safety efforts with the global surgery movement to maximize the effect of the checklist and improve surgical safety in low- and middle-income countries.