We identified common themes that have aided or hindered the introduction of the WHO checklist in England and have translated these into recommendations to guide the implementation of improvement initiatives in surgery and wider health care systems.

The WHO checklist has the potential to reduce preventable adverse events in surgery. But A Vats and colleagues’ experience suggests that a careful and rigorous implementation plan is required to ensure that the checklist is used routinely and correctly

No abstract

BackgroundDespite the increased prevalence of bioethics research that seeks to use empirical data to answer normative research questions, there is no consensus as to what an appropriate methodology for this would be. This review aims to search the literature, present and critically discuss published Empirical Bioethics methodologies.MethodsMedLine, Web of Science and Google Scholar were searched between 15/02/12 and 16/06/13 to find relevant papers. These were abstract reviewed independently by two reviewers with papers meeting the inclusion criteria subjected to data extraction.Results33 publications (32 papers and one book chapter) were included which contained 32 distinct methodologies. The majority of these methodologies (n = 22) can be classed as either dialogical or consultative, and these represent two extreme ‘poles’ of methodological orientation. Consideration of these results provoked three central questions that are central to the planning of an empirical bioethics study, and revolve around how a normative conclusion can be justified, the analytic process through which that conclusion is reached, and the kind of conclusion that is sought.ConclusionWhen considering which methodology or research methods to adopt in any particular study, researchers need to think carefully about the nature of the claims they wish to generate through their analyses, and how these claims align with the aims of the research. Whilst there are superficial similarities in the ways that identical research methods are made use of, the different meta-ethical and epistemological commitments that undergird the range of methodological approaches adopted rehearse many of the central foundational disagreements that play out within moral philosophy and bioethical analysis more broadly. There is little common ground that transcends these disagreements, and we argue that this is likely to present a challenge for the legitimacy of the bioethical enterprise. We conclude, however, that this heterogeneity ought to be welcomed, but urge those involved in the field to engage meaningfully and explicitly with questions concerning what kinds of moral claim they want to be able to make, about normative justification and the methodological process, and about the coherence of these components within their work.

Mini-AbstractThe WHO checklist was associated with reduced case-mix adjusted complications following surgery that was most significant when all three components of the checklist were completed.Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care. 3 Structured Abstract ObjectiveTo evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Summary Background DataThere remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. MethodsData were collected from surgical admissions (6,714 patients) March 2010-June 2011 at five academic and community hospitals. The primary endpoint was any complication, including mortality, occurring prior to hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. ResultsSignificant variability in checklist usage was found: while at least one of the three components was completed in 96.7% of cases the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of post-operative complication (16.9% vs. 11.2%) and was largely noticed when all three components of the checklist had been completed (OR 0.57, 95% confidence interval 0.37-0.87,p<0.01). Calculated population attributable fractions (PAF) showed that 14% (95% 4 confidence interval 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. ConclusionsChecklist implementation was associated with reduced case-mix adjusted complications following surgery and was most significant when all three components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.