Clinical care checklists: salvations or frustrations?

Abstract

The chief of surgery at a large private hospital read a paper reporting that implementation of a comprehensive surgical checklist greatly improved mortality and morbidity. The hospital has agreed to cover the cost of implementation. A special meeting of the surgical staff on implementing the checklist did not go well. The opposition to checklists ranged from residual chafing about past experience when practice guidelines went awry to acerbic assertions that the hospital's leadership has no right to tell surgeons how to practice. A dozen surgeons abruptly left, and all except a handful were piqued. Most agreed that the data may be flawed and that the hospital should therefore wait until additional data confirm the results. What should the chief of surgery do? A. Institute the checklist. Colleagues will appreciate the results later. B. Form a committee to evaluate the data. C. Wait for confirming papers to appear in the surgical literature. D. Start a pilot study with volunteer surgeons. E. Move to a new hospital where the staff is more progressive.