Love it or hate it – How a simple checklist and better communication is helping improve patient safety in Wales

It’s amazing to look back and see how far the NHS has come since the early days of surgery.

Unfortunate souls that went under the knife in the Nineteenth Century could expect gruesome pain, rampant infections, generous blood loss and post-operative shock, and not very good odds on survival!

Nowadays, nearly half a million people have surgery every year in Welsh NHS hospitals and these patients can expect to be greeted by highly-trained staff, using highly-advanced surgical techniques, high-tech equipment and highly-effective anesthesia.

I’m happy to say that our report, Operating Theatres – a summary of local audit findings, shows that Wales is continuing to make good progress on improving the safety of surgical patients.

Use of the World Health Organization’s Surgical Safety Checklist is growing. The WHO says the list should be used by theatre staff for ‘improving the safety of their operations and reducing unnecessary surgical deaths and complications’. And it’s great news that the checklist is becoming more and more widespread in Wales.

But more can be done.


One issue is that the checklist is Marmite. Many staff love it and some don’t. Some staff see it as a clear, concise tool for double checking that everyone is on the ball, but perhaps a minority of others see it as a patronising list that states the “bleeding obvious”!.

For the checklist to work properly, all members of the theatre team need to be involved, and they need to buy into the value of doing it.

I was interested to find that the use of the checklist varies by theatre. Sometimes all members of the team are involved, sometimes it is done without the surgeon or anesthetist being there.

For what it’s worth, I like Marmite. And I like the checklist because it is ultimately a team communication tool, and if it’s done in the right spirit, it can make surgery safer. What better motivation can there be?

Our report also looked at how efficiently NHS bodies are using their operating theatres. Given that operating theatres are expensive, costing around £14 per minute, per theatre, it is perhaps not surprising that we found plenty of scope for theatre time to be used more effectively by doing as much as possible to avoid late starts and early finishes and to minimise the gaps between patients.

Of course safety must always be the absolute priority. And no one is saying that theatres should become a conveyor belt or factory production line. But if health bodies can use their theatres more efficiently, they will cut waiting times. Having had a couple of personal experiences of the waiting list in recent years, I’m sure that anything that cuts waiting times whilst maintaining safety would be welcomed with open arms.

Our report acknowledges that the problems will not be easy to solve. Theatre efficiency is affected by problems that happen before surgery, during surgery and after surgery. Planned surgery can be affected by unforeseen emergency cases which need to take priority, and by well documented problems with bed availability. These problems often combine to result in cancelled operations, which can be hugely frustrating for both the theatre staff and patients, and they require solutions which go much wider than the theatre team. A lot of operations are also being cancelled as a result of actions by the patient, such as not turning up for their scheduled procedure, showing the need for a wider public responsibility to ensure our scarce NHS resources are used effectively.

If the NHS in Wales is to continue to make strides in the future, in terms of both safety and efficiency of its operating theatres, the answer for me, lies in teamwork, and good communication with patients. The solutions are about galvanizing everyone involved in a surgical patient’s care to smooth out the problems. The benefits will be worth the effort for everyone.

About the author: Stephen Lisle was the project lead for the work on Operating Theatres and has worked at the Wales Audit Office since 2005. Outside work, his love of sport has taken its toll on his knees, hence his experience of the waiting list.

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