[5] In 2004, the World Health Assembly (WHA) founded the WHO Patient Safety international alliance in order to tackle issues of adverse effects in unsafe healthcare.
[11] In particular, Gawande praised the impact of pilot checklists in mitigating aviation disasters, tracing their development back to disastrous test flights of the Boeing B-17 Flying Fortress.
[12] Gawande points to how checklists can be applicable in medicine by ensuring that practitioners do not skip important steps in procedures, both in complex, high-stress situations and in seemingly routine ones.
[12] In compiling what would become the WHO Surgical Safety Checklist (SSC), the Safe Surgery Saves Lives group set out three goals: simplicity, wide applicability, and measurability.
[13] This drew some influence from a prior study that showed a significant decrease in central line infections following the use of a checklist that detailed the basic steps and hygiene requirements (hand-washing; avoidance of the femoral vein; use of chlorhexidine soap; use of sterile PPE and barrier drapes; and daily inspection for possible removal).
[14][6] The checklist places its nineteen items into three "phases" of a surgical procedure: sign-in (before induction of anesthesia, while the patient is still conscious); time-out (with the surgeon present, before skin incision); and sign-out, based on the Joint Commission's Universal Protocol.
[15] At each of these phases, the surgical team members present stop and make sure that the corresponding safety items have been performed (or that there is a valid reason to waive that requirement for the procedure).
[31] In addition, cultural differences caused compliance issues with certain items on the checklist, such as placing marks on the body in Thai hospitals or perceived awkwardness in introducing oneself.