Jeremy Laurance: Sometimes, it's the simple things that work best

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The Independent Online

Nothing better illustrates the urgent need for the surgical checklist, now to be implemented across England and Wales, than the terrifying experience of a woman patient admitted to a central London hospital last August for a gynaecology operation.

Owing to a mix-up that remains unexplained, she found herself in the wrong place at the wrong time, which resulted in her wrongly having her gall bladder removed.

The woman, who recovered and has since received the correct treatment for her gynaecological condition, has not been identified. But the hospital has – it was St Mary's, the very hospital (and the only one in Britain) where the checklist was being piloted.

The hospital has apologised for the error and stressed that it occurred in a theatre that was not using the checklist. But the lesson is clear – even the finest hospitals in the world (St Mary's has an international reputation) are capable of making the most basic mistakes.

The beauty of the checklist is that it is simple, virtually cost-free, and likely to save more lives than a whole bunch of "miracle" cures. While doctors may scoff that the questions included (Is this the right patient? Is this the right limb?) are too blindingly obvious to require more bureaucracy, patients will almost certainly be astonished that such rules do not already exist.

But it is important not only for what it is designed to achieve – safer operations – but also for what it signifies – a new focus on the quality of care.

For the past 60 years we have asked only one question of the NHS – whether it is doing enough and why it is not doing more. Now we are starting to ask whether it is doing it right and how we can help it to do it better. Access – that is, waiting lists – is no longer the problem. Quality is the new battle cry. Doctors may dismiss the checklist as tick-box medicine which threatens to turn them into automatons. But it is actually designed to free them to use their skills to treat patients without having to think about tasks that ought to be routine.

The surgical checklist, and those being prepared for other clinical areas, fits with much else that is going on in the NHS – the focus on health outcomes being pioneered by Lord Darzi, the publication of death rates and increased involvement of patients in rating doctors and hospitals. It is a new beginning.

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