Safer Surgery

In a nutshell: The expansion of surgery and many technological advances have delivered considerable benefits for patients, However the environment is now so complex that no individual member of staff can maintain a constant awareness of all the factors relevant to patient safety. As a result the number of patients who receive their treatment as expected is surprisingly low, with the number of patients who experience an error as a consequence of their treatment being surprisingly high and a fatal incident rate estimated at one per 10,000 (NPSA 2009).

How to make surgery safer?

Why do things go wrong? The evidence from across the world demonstrates that the recognised sources of error in surgery include human fallibility, miscommunication, poor co-ordination of team activity, human-technology interaction and sub-optimal management of the environment. To make surgery safer there is therefore a need to reduce the scope for error from each of these sources. The WHO Safer Surgery Checklist (2007) was devised to assist in this. Its primary purpose was to help us deal with complexity through:

  • Decentralisation of power
  • Shift in team structures from 'Hierarchy' to 'Heterarchy'
  • Empower each team member

Implementation of the WHO Checklist has had variable levels of success. Often the checklist is treated as a tick-box exercise. This is not in keeping with the stated intention for the checklist when it was developed, which was to improve culture and promote better team working by helping to address some of the problems surrounding the excessively hierarchical nature of theatre environments.

We need to address the Human Factor issues that arise in strictly hierarchical environments which make 'speaking up' difficult. We also need to ensure staff are engaged with the process of making care safe at every stage. When initiatives are imposed from above, without clear explanation as to their rationale and usefulness, they are less likely to be effective.

Effective, inclusive leadership is essential at every level – ranging from within each theatre to the higher levels of management. 

Our Work

The improvement academy is working with a group of theatre teams to design and test a behavioural change approach to successfully use safety briefings and the WHO Checklist.

A range of tools and case studies are being developed through our work with frontline clinical teams. The Improvement Academy will share the strategies used to address issues and their impact.

ABC for Patient Safety Toolkit

Click here to access our Achieving Behaviour Change Toolkit resource, including information on how to apply it along with a worked example.

Further Information:

Who Checklist

WHO multi curricular guide

WHO Checklist - Its Value and Limitations presentation, .

Clinical Human Factors group

NRLS - 10 for 2010: Five steps to safer surgery

NHS England - New recommendations to further improve surgical safety



Mel Johnson - Patient Safety Collaborative Programme Manager


01274 383931