The WHO Surgical Safety Checklist

Rehabilitation and Hospitals

Author: New Zealand Government
Published: 2009/08/27
Contents: Summary - Introduction - Main - Related

Synopsis: The Surgical Safety Checklist we are launching this morning is a great example of both.


In Health we are very good at setting up systems to detect when something has gone wrong and to investigate the causes. What we're not so good at yet is spending the time to avoid making the mistakes in the first place.

Main Digest

Tony Ryall

27 August, 2009
Speech to launch the WHO Surgical Safety Checklist

Good morning everyone and welcome to Parliament.

Thank you Professor Alan Merry - Chair of the College of Anesthetists' Quality and Safety Committee.

I'd like to acknowledge my Parliamentary colleagues present here today, Jackie Blue from the Government, Ruth Dyson and Iain Lees-Galloway from Labor, and Kevin Hague from the Greens.

Welcome Professor Jean-Claude Theis - New Zealand Chair of the College of Surgeons, Dr Vanessa Beavis, New Zealand Chair of the College of Anesthetists and Ian Civil -Censor in Chief - College of Surgeons.

The Director General of Health tells me the number of senior surgeons, anesthetists and nurses present this morning has him quite worried about the level of surgical output in New Zealand hospitals today.

Thank you for inviting me to formally launch the Surgical Safety Checklist in New Zealand.

In Health we are very good at setting up systems to detect when something has gone wrong and to investigate the causes. What we're not so good at yet is spending the time to avoid making the mistakes in the first place.

The National Government is committed to improving quality and safety in the public health service and we are committed to ensuring that it is clinicians who lead those improvements.

The Surgical Safety Checklist we are launching this morning is a great example of both.

Modern medicine is a highly complex business and getting more so all the time. American obstetrician- Dr Charles Lockwood from New Haven, Connecticut - has said that "to conscientiously practice medicine in the 21st century requires one to remain in a chronic state of angst, wondering "Did I forget something crucial"

He says patients see so many different health professionals during their time in hospital and have so many notes and updates and documents in their medical records, that it's a challenge for any one person to get a handle on that patient's overall health status.
That is a point the Health and Disability Commissioner has made on many occasions.

Doctors and nurses suffer perpetual information overload - it is increasingly harder for one person to remember everything, or for a large team to be sure they have everything covered in a high stakes situation such as surgery.

The Ministerial Review Group Report released ten days ago suggests that in New Zealand there are substantial human and financial costs associated with medical error.

Most patients receive good care most of the time. However the Report estimates 44 thousand people admitted to hospital suffer an unintended injury caused in the management of their conditions, rather then the underlying disease - this is a similar rate to other countries. Although most of those people had relatively minor adverse events, about 15% resulted in permanent disability or death.

I think we would all say that is unacceptable.

The MRG Report also estimates that around $600 million in hospital expenditure goes towards treating potentially preventable adverse events. That's money we would otherwise be spending on treating more patients.

If we can improve quality and safety and prevent even 20% of this it will significantly improve the lives of those patients - and it could free up around 20,000 extra operations in the New Zealand public health system.

The previous government began improving quality and safety in the public health service. We are carrying on with it. We just need to do more, more quickly.

The Ministerial Review Group Report recommends an independent national quality agency be established to build on the work initiated by the Quality Improvement Committee. The Government will be considering that seriously.

The report also says existing initiatives should become business as usual in the DHBs and we should ask clinicians to build on them and add what they see as most important to saving lives and preventing harm.

I am therefore pleased that New Zealand clinicians and managers have played such a strong role in developing and trialling the WHO's Surgical Safety Checklist we are launching today.

You know I was intrigued to learn how it came about - that we have World War Two B - 17 bomber pilots to thank for this new clinical tool.

Prepping for the airplane's second test flight, the crews forgot to release the airplane's 'gust lock' - which resulted in the plane climbing some thousands of feet into the air , then stalling and nose diving into the ground.

The crash investigation found that the increased complexity of flying the bomber had resulted in pilot error - they wondered if it was too much plane for one person to fly.

But they came up with a simple solution - the pre flight test - a version of the one we've all come to know well from movies and TV shows, and probably one every small child in love with planes can recite without prompting.

According to American surgeon and writer, and leader of the WHO Surgical Safety Checklist project, Atul Gawande, medicine today has entered its B-17 phase.

A lot of medicine - especially in hospitals - has become too complex for clinicians to carry out on memory alone. Clinicians and clinical teams need to do what those World War Two bomber crews realized they had to do. Like those pilots they must set time aside to systematically check they've done all the important things for the flight - or operation - ahead.

The World Health Organization -with the collaboration of surgeons, nurses, anaesthesiologists, and patient safety experts from around the world - has done just that.

It has formulated the Surgical Safety Checklist using peer-reviewed evidence and expert consensus, then trialled it in a selection of hospitals around the world.

One of those was our own Auckland City Hospital, and I commend Auckland on their participation in this study. It is great to see New Zealand taking an active role in leading healthcare innovation.

The checklist has a strong focus on teamwork and communication in the operating room, because increased teamwork in surgery has been linked to improved surgical outcomes and significantly reduced rates of adverse events.

But the main role of the checklist is simply to ensure thoroughness and consistency - that all necessary steps are completed, all the time.

The results of the World Health Organization's trial were impressive. Use of the checklist reduced the rate of deaths and complications by more than one third across the eight pilot hospitals.

It is such a simple improvement, yet it has such significant effect, providing better outcomes, and less time in hospital for patients - at effectively no cost to the health systems involved.

I strongly encourage all clinicians with the support of their managers and Colleges to adopt the Surgical Safety Checklist in their hospitals.

I'd like to acknowledge the four medical colleges who have endorsed the Surgical Safety Checklist we launch today and who will be actively supporting its use throughout New Zealand and Australia, in both the public and the private sector.

They are the Royal Australasian College of Surgeons, the Australian and New Zealand College of Anesthetists, The Royal Australian and New Zealand College of Obstetricians and Gynecologists and the Royal Australian and New Zealand College of Ophthalmologists.

I understand the New Zealand Nurses Organization also supports the Surgical Safety Checklist along with the Private Surgical Hospitals Association Executive and the Quality Improvement Committee.

This is a very big world movement and New Zealand has played a not inconsiderable part - Professor Alan Merry led one of the four WHO working parties that developed the Checklist and Auckland Hospital was the only Australasian hospital to trial it.

So it is with pleasure I launch the Surgical Safety Checklist in New Zealand.

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