Scaling Safety: The South Carolina Surgical Safety Checklist Experience

Health Aff (Millwood). 2018 Nov;37(11):1779-1786. doi: 10.1377/hlthaff.2018.0717.


Proven patient safety solutions such as the World Health Organization's Surgical Safety Checklist are challenging to implement at scale. A voluntary initiative was launched in South Carolina hospitals in 2010 to encourage use of the checklist in all operating rooms. Hospitals that reported completing implementation of the checklist in their operating rooms by 2017 had significantly higher levels of CEO and physician participation and engaged more in higher-touch activities such as in-person meetings and teamwork skills trainings than comparison hospitals did. Based on our experience and the participation data collected, we suggest three considerations for hospital, hospital association, state, and national policy makers: Successful programs must be designed to engage all stakeholders (CEOs, physicians, nurses, surgical technologists, and others); offering a variety of program activities-both lower-touch and higher-touch-over the duration of the program allows more hospital and individual participation; and change takes time and resources.

Keywords: Hospitals; Organization and Delivery of Care; Quality Of Care.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Checklist / methods*
  • Checklist / standards
  • Health Plan Implementation / methods
  • Hospitals / statistics & numerical data*
  • Humans
  • Operating Rooms / standards*
  • Patient Care Team / standards*
  • Patient Safety / standards*
  • Patient Safety / statistics & numerical data
  • South Carolina
  • Surgical Procedures, Operative / mortality
  • Surgical Procedures, Operative / standards*