PRESIDENT’S MESSAGE
Is the Use of Surgical
Checklists Thriving in
Your OR?
 MN, RN, CNOR, AORN PRESIDENT
RENAE N. BATTIE,
J une is a time for us to celebrate the tremendous progress
that has been made in implementing the time out for
surgery. Newer perioperative nurses may not remember
a time when there was not the expected pause before surgery.
As awareness of wrong-site, wrong-patient, wrong-procedure
surgical events grew, the time-out process was established as
a means to perform a final review of key pieces of information
(eg, patient, procedure, site) immediately before surgery. In
2004, AORN initiated National Time Out Day as an aware-
ness campaign for the public and a call to action for all surgical
team members to improve patient safety. National Time Out
Day, recognized June 10 this year, is supported by The Joint
Commission and the World Health Organization as a strategy
to increase awareness of key patient safety practices associated
with the time out.
Tremendous strides have been made by the World Health
Organization in recent years to improve surgical safety
worldwide through the use of surgical safety checklists. Atul
Gawande, MD, MPH, a surgeon, writer, and public health
researcher who practices general and endocrine surgery at
Brigham and Women’s Hospital, Boston, drew additional
attention by publishing his 2009 book, The Checklist Manifesto:
How to Get Things Right.1 These gains have helped
established the use of a surgical safety checklist that
includes the key elements of the surgical time out as the
new, higher standard for surgical safety.2 Much has been
written about the effects of surgical checklist use on
improving teamwork, communication, and safety.3 It is
time to celebrate our progress as teams and consider what
work lies ahead of us.
http://dx.doi.org/10.1016/j.aorn.2015.04.009
ª AORN, Inc, 2015
www.aornjournal.org
FORMING STRONG TEAMS
We are still learning about what variables affect team strength,
and some of our knowledge about teams comes from sports. I
have been fortunate to play team sports, and I currently play
on a co-ed recreational softball team that has a core group of
players who have been together for more than 20 years.
Although we often play against younger teams, the strength we
have in knowing our teammates gives us some advantages that
newer, younger teams do not have. We have a high level of
trust in each other’s intentions and preparation, and we have
the knowledge of how best to use each other’s skills. Of course,
this is a fun, recreational example, so the analogy only goes so
far. However, in the high-stakes arena of surgery, knowledge of
each surgical team member is an asset; thus, introductions
have become an important part of the surgical check-
list process.
Name familiarity has been shown to improve the ability to
speak up, which is a hallmark of a safety culture, and clarity of
roles and responsibilities also helps make a team strong.
Because surgical teams can change from surgery to surgery and
even within surgeries, making assumptions that all members
know each other and each other’s roles can be dangerous. The
surgical checklist directs us to consider the unique contribu-
tions and observations of each person to add to the shared
knowledge and awareness of the entire teamdwhether it is
about one team member’s fatigue, items from the preoperative
assessment that have arisen, or a delay in the arrival of a specific
item for the surgery. Hearing each team member’s voice is a
means to acknowledge the value of each team member’s
contributions.
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e June 2015, Volume 101, No. 6
A great team looks for ways to help each other improve, so that
the combined strengths are greater than any individual
contribution. Building a strong, effective surgical team requires
fostering trust and safety in all interactions with team members
and ensuring clear communication and leadership.4 In sports,
there are teams that have a superstar, and the fate of the team is
often dependent on that individual’s skills; however, most
winning teams espouse a philosophy of all members
succeeding together by drawing on each other’s strengths. It
has been said that “there is no ‘I’ in team.” We strive to
align this philosophy with the safety work of the surgical
team, who may be meeting each other for the first time
before surgery begins. The time out allows us to establish
the “we” or the team identity. It is similar to a team huddle
before the start of a game.
Knowing each other, understanding each other’s roles, valuing
each other’s contributions, and making sure the time-out
process supports the value of each team member continue to
be important elements of making our ORs a safe place to
practice and receive care. It is important to continually assess
our own practice to see if our actions are in alignment with
evidence-based practices. Do we model the importance of
listening to team members by taking time to listen to a hand-
over report and confirm there are no questions, even when we
are anxious to finish our shift? Do we seek the perspective of
each team member when there is an adverse event or a
problem? Do we audit surgical checklist use to ensure that,
over time, it is still being followed consistently? Are new sur-
gical team members informed and coached on how to actively
participate? Are we sharing the latest evidence about the
importance of the time out and the safety checklist? Are we
actively reviewing and updating the checklist to meet the
unique needs of the populations at our own sites?
It is important for surgical team members to be fully engaged
and present when participating in the checklist and to respect
the process. At my organization, we have been discussing
situational awareness and mindfulness and what it means to be
fully present. I once heard a football coach use the phrase “be
where your feet are,” and I thought it had application to what
perioperative team members do. It is easy to multitask or
become distracted by work or personal issues. During the time
out and completion of the surgical safety checklist, it is
important to be where your feet aredfully present, fully
engaged, and listening. I heard a speaker recently discuss using
598 j AORN Journal
an intentional deep breath as a tool to reconnect the body and
the braindperhaps we should add “deep breath in/out” as the
first step of the surgical safety checklist as a way to make sure
everyone is where their feet are!
CONCLUSION
Celebrating the time out and the use of surgical safety
checklists is an effort to help the public understand the gains
that have been made in surgical safety. However, there is more
to do. AORN continues to collaborate with The Joint
Commission and the Council on Surgical and Perioperative
Safety to emphasize the importance of surgical checklists. This
month, we emphasize the value of the time out for patient
safety. The first issue of the “AORN Quality & Safety Special
Report” will be sent to all AORN members via e-mail in June
and will focus on the prevention of wrong-patient, wrong-site,
wrong-procedure events, which represent the second most
commonly reported sentinel event category.5 Watch for this
special report and take time to review the articles in this
month’s AORN Journal that focus on preventing surgical

errors and making use of the surgical checklist. Our patients
depend on us to be vigilant!
References
1. Gawande A. The Checklist Manifesto: How to Get Things Right. New
York, NY: Metropolitan Books; 2009.
2. Surgical Safety Checklist. World Health Organization. http://whqlibdoc
.who.int/publications/2009/9789241598590_eng_checklist.pdf.
Updated January 2009. Accessed March 30, 2015.
3. Lyons VE, Popejoy LL. Meta-analysis of surgical safety checklist
effects on teamwork, communication, morbidity, mortality, and
safety. West J Nurs Res. 2014;36(2):245-261.
4. Shuhaiber J. The quest for safe surgical care: are we missing the
obvious? Bull Am Coll Surg. 2014;99(2):42-45. http://bulletin
.facs.org/2014/02/the-quest-for-safe-surgical-care-are-we-missing
-the-obvious/#. Accessed March 30, 2015.
5. Sentinel event data e general information (1995-2014). The Joint
Commission. http://www.jointcommission.org/assets/1/18/General_
Information_1995-2Q_2014.pdf. Accessed April 16, 2015.
 , MN, RN, CNOR
Renae N. Battie
is the AORN President and the associate vice president,
Perioperative Services, at CHI Franciscan Health, Tacoma,
Washington. Ms Batti e has no declared affiliation that
could be perceived as posing a potential conflict of
interest in the publication of this article.
www.aornjournal.org