doodlecheck.

WHAT THE EVIDENCE SAYS

Pause. Check.
Then go.

Experts forget steps too. A short list catches them.

The World Health Organization's surgical checklist asks a whole team to stop at three moments and confirm the basics. UK aviation guidance shows how to design lists people will actually use under pressure.

Fix a checklist Read the short answer
An operating theatre team in caps and masks gathered around the table for a short pause before an operation, seen from behind
AI-generated image, not a photograph of a real person or place.
01 Pause at set moments02 Number every step03 Keep it shortLessons from theatres and cockpits

THE SHORT ANSWER

A list is a pause
with a purpose.

Checklists do not replace skill.
They make sure the basics happen every time.

THE THEATRE

Three pauses per operation

The WHO Surgical Safety Checklist has 19 items, checked by the whole team before anaesthesia, before the first incision and before the team leaves the operating room.

See the numbers

THE COCKPIT

Design for pressure

The UK Civil Aviation Authority warns that long or confusing procedures make crews cut corners, skip items or ignore the checklist altogether.

Fix a checklist

AT HOME

Borrow the habits

The same ideas work on any list: number the steps, keep it short, make it easy to read and re-check after an interruption.

Write your own

A QUICK CHECKLIST CHECK

What goes wrong
with your list?

Pick a common checklist problem to see the fix that UK aviation guidance recommends. The bar shows how big a change the fix asks for.

Based on the CAA's CAP 676, written for emergency and abnormal checklists on the flight deck. The design ideas carry over to everyday lists.

List check

Choose a problem
It is hard to readBigger, plainer type

Use black text on white or yellow, a clear sans serif font and lower case with capital initials. Research cited by the CAA found lower case easier to read than capitals.

People skip a stepNumber the steps

Numbering every step helps, as does extra emphasis where two steps look similar.

Someone gets interruptedRe-check what is done

Number the steps and agree what happens after an interruption. The CAA recommends re-verifying the actions already completed.

Too much to rememberFour or fewer

Keep steps done from memory to a minimum, preferably four or fewer, because recall can be impaired under stress.

Nobody uses itMake it shorter

Lengthy or confusing procedures make people revert to their own methods, cut corners or ignore the list entirely. Shorten and clarify it, then train people on it.

Source: UK Civil Aviation Authority, CAP 676, Guidance on the Design, Presentation and Use of Emergency and Abnormal Checklists (Issue 3, 2006).

TWO NUMBERS WORTH KNOWING

One list,
eight hospitals.

From the 2009 WHO study in eight hospitals,
including one in London, before and after the checklist.

DEATHS · NEJM 2009

Inpatient death rate after surgery

1.5 → 0.8<small>%</small>

In 3,733 patients before and 3,955 after the checklist was introduced, the death rate fell from 1.5% to 0.8%.

COMPLICATIONS · NEJM 2009

Inpatient complication rate

11 → 7<small>%</small>

Complications fell from 11.0% of patients to 7.0%. WHO describes this as a reduction of more than one-third in deaths and complications across the pilot hospitals.

The study compared outcomes before and after the checklist, so it shows an association. WHO notes that later studies, including a randomised trial in Norway, also found fewer complications.

A hand with a pencil ticking boxes on a short handwritten list on a notepad on a wooden kitchen table
AI-generated image, not a photograph of a real person or place.

FOUR RULES FOR ANY LIST

Short, numbered,
readable.

These rules come from aviation guidance on checklist design, and they work as well for a packing list or a shutdown routine as on a flight deck.

  1. Cut it downLengthy or confusing lists invite shortcuts. Keep only the steps that matter and that people really might miss.
  2. Number every stepNumbers stop people losing their place and make it easy to see where you were if you are interrupted.
  3. Make it readable at arm's lengthThe CAA suggests 12 point text, 14 point headings, black on white or yellow, and lower case rather than blocks of capitals.
  4. Restart carefullyAfter an interruption, go back and confirm the steps already ticked before carrying on.

WHY IT WORKS

Not just the list,
the team around it.

WHO suggests the benefit has several sources: the checklist, the formal pauses, and better teamwork and communication. Studies have reported staff more likely to speak up when they notice a problem.

Results were better when the checklist was completed in full. And a mandatory roll-out in Ontario with no measured benefit taught WHO that simply telling people to use a checklist will not work: it takes training, local champions and adaptation.

A pilot's hands in a small aircraft cockpit holding a laminated checklist card, the instruments softly out of focus
AI-generated image, not a photograph of a real person or place.

QUESTIONS PEOPLE ASK

Frequently asked

What is on the WHO surgical checklist?

It has 19 items covering key safety checks, done by the surgeons, anaesthesia providers and nurses together at three moments: before anaesthesia, before the first incision and before the team leaves the operating room.

Did the checklist really reduce deaths?

In the 2009 study in eight hospitals, deaths fell from 1.5% to 0.8% and complications from 11.0% to 7.0% after it was introduced. It was a before-and-after study, so it shows an association, and later studies reported similar benefits.

If teams already do the checks, why use a list?

WHO says many hospitals already do most of the checks, but very few operating teams do them all consistently. The checklist helps make sure every step happens for every operation.

How long should a checklist be?

As short as it can be while still useful. The CAA warns that long or confusing procedures lead people to cut corners or ignore the list, and suggests keeping memory items to four or fewer.

Can a checklist be changed for local use?

Yes. WHO encourages adapting its checklist to local settings after consultation, and lists local adaptation, training and feedback among the factors behind successful use.

SOURCES

Where the facts come from

Each figure on this page comes from the sources below. Check them for the full detail and context.

  1. WHO: Patient safety, Safe surgery saves lives, questions and answers
  2. WHO: Safe surgery tool and resources, WHO Surgical Safety Checklist
  3. Haynes et al. (2009), A surgical safety checklist to reduce morbidity and mortality in a global population, NEJM (PubMed)
  4. UK Civil Aviation Authority: CAP 676, Guidance on the design, presentation and use of emergency and abnormal checklists