The WHO Surgical Safety Checklist: A Review of Outcomes and Implementation Strategies

Bardia Barimani, Pouyan Ahangar, Rajpal Nandra, Keith Porter

Research output: Contribution to journalReview articlepeer-review


Human error or systematic failures can cause harm to patients and both direct and indirect costs to healthcare trusts. In response, surgical safety has become a vital component of modern healthcare worldwide. Safe execution of surgery is even more important as an increasing number of surgical interventions are occurring annually. The World Health Organization (WHO) addressed the issue of safety in the operating theatre by producing the WHO Surgical Safety Checklist (WHOSSC) in 2008. This checklist enforces the scrutiny of routine tasks known to influence procedural efficiency and patient outcome throughout the whole patient journey from the ward, through surgery and anesthesia, recovery and eventually back on the ward. Implementation of the WHO checklist faced resistance and barriers to change. Through a literature review we describe the evolution of checklists and report effects on outcomes and safety enhancements. This article will summarize the lessons learnt from its implementation thus far and suggest several avenues where checklists will enhance patient safety and multi-disciplinary communication in surgical patients. Here, we conducted a literature review of PubMed with the aim of studying the effectiveness of the WHO surgical safety checklist in improving patient safety and outcomes. We found that majority of studies reported an improvement in outcomes for patients after implementation of the WHOSSC. The major limiting factor for successful implementation was lack of adherence to full completion of the checklist. A major barrier to adoption has been lack of a streamlined and cohesive approach in implementing the checklist, making its adoption difficult within the complex and dynamic environment of the operating theatre. Implementation of the surgical checklist bears negligible costs, while saving institutions thousands of dollars through preventing costly complications, making it a worthy investment for hospitals. We found the WHO Surgical checklist to be an extremely important facet of enhancing patient safety with better outcomes when users are well trained and enthused with its use.

Original languageEnglish (US)
Article number100117
JournalPerioperative Care and Operating Room Management
StatePublished - Dec 2020
Externally publishedYes


  • Anesthesia
  • Checklist
  • Collaboration
  • Communication
  • Complications
  • Literature Review
  • Operating Room
  • Outcomes
  • Patient Safety
  • Stop before you block
  • World Health Organization Surgical Safety Checklist

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine
  • Medical–Surgical
  • Anesthesiology and Pain Medicine


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