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SCP: WHO Surgical Safety Checklist
Stepwise approach to implementation

The following outlines the key steps for getting started on implementation of WHO Surgical Safety Checklist (modified from the “Implementation Manual WHO Surgical Safety Checklist“, WHO 2009c).

1. Secure senior leadership commitment

Successful implementation of the WHO Surgical Safety Checklist requires sincere commitment by the HCOs' leaders. The chiefs of surgery, anaesthesia and nursing departments should publicly embrace the belief that safety is of high priority and that the use of the checklist can help to make it reality.

2. Form a team

The commitment by all team members that are involved in surgical procedures is essential. There should be a core group of people who are enthusiastic about the WHO Surgical Safety Checklist. At this early stage it is recommendable to work with those who are interested rather than trying to convince the most resistant people.

Representation of the core group could include:

o colleagues from as many relevant clinical disciplines (surgery, anaesthesia, nursing) as possible; it would be good to include at least one member from each of the disciplines

o HCOs' leaders

o Administrators

3. Start small, then expand

Start small

Test out the WHO Surgical Safety Checklist in one operating room with one team.

Expand

Move forward, when...

o one team is comfortable using the checklist,

o problems have been addressed,

o enthusiasm builds.

Discuss the efforts with different surgical departments and surgeons and make sure that those team members who were originally involved in the process are using the checklist in their own operating rooms.
Address resistance as it arises. Involve clinicians who have used the checklist and have had good experiences with it as champions for promoting the checklist and for defending its use and spread in the HCO.

4. Track changes and improvements (evaluation)

HCOs should collect data for process and outcome measures to see if the standards are being followed and implementation has been successful.

Process measures:
Process measures may help identify safety lapses and areas for improvement. Suggestions for measurement are the frequencies of compliance with e.g. verbal confirmation of patient, site and procedure immediately before incision with all team members present (further suggestions can be found in the WHO Implementation Manual which is included in this tool box).

Outcome measures:
The monitoring and evaluation of outcomes is an essential component of surgical care and WHO highly recommends the establishment of a monitoring system. For example, death on the day of a surgery and postoperative in-hospital mortality deaths should be collected systematically.

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