Safe Surgery 2015: What's to come and your part in it

South Carolina’s hospitals have been charged with leading the nation on a mission that could potentially save thousands of lives in the next decade.  Safe Surgery 2015 is a quest to have every hospital operating room in the United States using the safe surgery checklist successfully in less than five years. Being a leader always means taking on more responsibility. For South Carolina hospitals, that means accomplishing this by 2013.

“To pull this off will be the most difficult thing you will do in your operating room in your lifetime,” said Michael Rose, MD, vice president of surgical services at McLeod Health and moderator of the 4th Annual South Carolina Patient Safety Symposium’s “Safe Surgery 2015: What’s to Come and Your Part in It.” 

“Start small. Do not do a big-bang roll-out because you will die on a hill of resistance,” was the advice offered by Safe Surgery 2015 Program Director Bill Berry, MD, MPH. “Talk to people ahead of time one on one.”

Berry was joined by his team – Research Director Sunil Eappen, MD and Project Manager Lizzie Edmondson – all from the Harvard School of Public Health, for a session to present a comprehensive “who, what, when and how” of successfully implementing the Safe Surgery 2015 checklist in a hospital setting. 

The presentation outlined key steps and strategies for implementing the checklist, emphasizing the importance of working within individual hospitals through the support of individual staff.  Berry stressed the critical importance of forming an implementation team that includes nursing, administration, anesthesia and surgery in the earliest stages of the process. 

Every hospital and every surgical theater is different, so the first task for the implementation team is to customize the standard surgery checklist to suit their hospital’s specific needs. Using their collective experience and training, the team members must determine which parts of the checklist to keep, omit, alter or add. This process will enhance ownership by the team and target specific needs of the surgeon. 

“During the modification process, it may be useful to practice using the checklist in various forms. Practice the checklist in one form, then debrief, modify and practice again,” said Berry.  “When you feel like you’ve finally created the final version, use the checklist for an entire day using the same team. Look at the results, debrief and modify again as necessary.” 

Though customization is necessary, Berry also stressed the importance of keeping the team introductions, briefing and debriefing on the checklist. The goal of the checklist is two-fold: to improve surgical performance and to improve communication between members of the surgical team.  “I remember cases where there’d be someone standing in the corner of the operating room and I had no clue who they were. They could have been someone from the street,” said Berry.  Staff introductions help to eliminate this issue and encourage everyone in the operating room to feel like they have a voice.  

When the checklist is final, the next step is to empower “clinical champions”– the people who will help gain staff acceptance of the checklist and facilitate its implementation. Acknowledging that the task of locating appropriate (and willing) champions might seem daunting, Berry said, but using the right resources can make it easier. He suggested relying on the knowledge of the nurses to help identify the surgeons who are most respected and trusted by hospital staff.

Throughout the presentation, Berry repeated his “start small” advice, urging his audience to move forward with a measure of comfort; take each next step only when you feel ready; and don’t hold yourself to stiff timelines. Successful implementation of the Safe Surgery Checklist depends entirely on the willingness of individuals to make it work. That willingness can vary from person to person and surgeon to surgeon. The process may seem difficult and slow at times, but the Safe Surgery 2015 team emphasized that the key is to keep pushing forward.

The Safe Surgery 2015 team discussed strategies for educating all operating room staff: anesthesiologists, nurse anesthetists, nurses, scrub techs and surgeons – both within a team context and individually. Personal contact with information about the checklist is important. The more personal it feels, the more likely it is to be successful.  Berry suggested making a video showing hospital staff using the safe surgery checklist from the beginning to the end of a surgery.

The session wrapped up with the admonition to “start small, but start now.” Create strong implementation teams and start scheduling many educational meetings. “For the Safe Surgery Checklist, it’s one step at a time, one individual at a time,” said Berry.

For more information on the Safe Surgery 2015 checklist, and to learn what you can do to help make it work, visit

05-18-2011 10:31 (EDT)