Hospital checklists are meant to save lives — so why do they often fail?

Emily Anthes in Nature:

Before making the first incision, confirm the patient's identity. Mark the surgical site. Ask about allergies. Discuss any anticipated blood loss. Introduce yourself by name. These are some of the 19 tasks on the World Health Organization (WHO) Surgical Safety Checklist, a simple list of actions to be completed before an operation in order to cut errors and save lives.

In 2007 and 2008, surgical staff at eight hospitals around the world tested the checklist in a pilot study. The results were remarkable. Complications such as infections after surgery fell by more than one-third, and death rates dropped by almost half. The WHO recommended that all hospitals adopt its checklist or something similar, and many did. The UK National Health Service (NHS) immediately required all of its treatment centres to put the checklist into daily practice; by 2012, nearly 2,000 institutions worldwide had tried it. The idea of checklists as a simple and cheap way to save lives has taken hold throughout the clinical community. It has some dynamic champions, including Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston, Massachusetts, who led the pilot study and has spread the word through talks, magazine articles and a best-selling book, The Checklist Manifesto (Metropolitan, 2009).

But this success story is beginning to look more complicated: some hospitals have been unable to replicate the impressive results of initial trials. An analysis of more than 200,000 procedures at 101 hospitals in Ontario, Canada, for example, found no significant reductions in complications or deaths after surgical-safety checklists were introduced.

More here.