In operating rooms around the world, some of the most advanced technology in medicine is used every day. Yet, one of the most powerful patient safety tools is remarkably simple - a 19-item checklist.

 

The WHO Surgical Safety Checklist, launched in 2008 as part of the “Safe Surgery Saves Lives” initiative, was designed to reduce preventable surgical errors through structured communication and teamwork.

 

More than a form to tick off, it is a behavioural tool, one that transforms how surgical teams interact, verify information and share responsibility.

 

In this blog, we’ll tell you what the World Health Organization Surgical Safety Checklist is and show you how video observation tools such as Codimg can be used to monitor the effective use of the checklist in real-world and simulated scenarios and debriefings.

 

So, let’s get started…

 

 

What Is the Surgical Safety Checklist?

The checklist was created by the World Alliance for Patient Safety, in conjunction with surgeons, anaesthesiologists, nurses, patient safety experts and patients, as part of the World Health Organization’s initiative to reduce surgical errors and deaths.

 

It is a set of safety checks that can easily be performed in a surgical theatre during an operation.

 

The checklist is structured around three critical pause points during surgery:

 

 

1. Sign In (Before Anaesthesia)

Before anesthesia begins, the team confirms:

 

• Patient identity
• Surgical site and procedure
• Consent
• Allergies
• Airway risk
• Blood loss risk
• Functioning monitoring equipment

2. Time Out (Before Incision)

Immediately before the first incision:

 

• Team members introduce themselves by name and role
• The procedure and surgical site are reconfirmed verbally by participants
• Antibiotics are confirmed (if required)
• Critical steps and expected blood loss are discussed
• Imaging is verified

 

Arguably, this is the moment where communication matters most.

3. Sign Out (Before Leaving the Operating Room)

Before the patient leaves:

 

• The procedure performed is confirmed
• Instrument, sponge and needle counts are checked
• Specimens are labeled correctly
• Equipment issues are discussed
• Recovery concerns are reviewed

 

These short pauses take only minutes, but they prevent wrong-site surgery, retained instruments, missed antibiotics, and communication failures.

 

How the Checklist Helps Medical Professionals

The impact of this checklist goes far beyond issues of compliance. Far from being a simple box ticking exercise, it has been designed to improve the overall culture of surgical teams.

Enhances Team Communication

Traditionally, there is an established hierarchy in the surgical theatre where the lead surgeon naturally takes the lead. But, at the end of the day, surgery is a team game and everyone must be involved.

 

Structured dialogue, such as that encouraged by the checklist, reduces hierarchical barriers and empowers nurses, anesthetists and junior staff to speak up.

Reduces Cognitive Load

In the operating room, clinicians must process large amounts of information while making rapid decisions under pressure. Even the most experienced professionals can overlook routine steps when attention is divided between the patient’s condition, the surgical procedure, and team coordination.

 

By externalizing critical checks, such as patient identity, antibiotic administration and instrument counts, the checklist frees mental capacity for clinical decision-making.

 

 

Prevents Never Events

“Never events” are serious, preventable incidents that should never occur in modern healthcare, such as wrong-site surgery, retained surgical instruments or operating on the wrong patient.

 

These events often result from breakdowns in communication, misidentification or missed verification steps rather than a lack of technical skill.

 

By requiring verbal confirmation of the patient, procedure, surgical site, and instrument counts, the checklist creates multiple layers of verification and shares responsibility across the surgical team.

Improves Accountability

As mentioned above, the surgical safety checklist encourages active participation from every member of the operating team. Each pause point requires verbal confirmation of key information such as the patient, procedure, and surgical site. 

 

This ensures that responsibility for patient safety is shared openly among surgeons, anesthetists, nurses and support staff.

 

It shifts the focus from passive compliance to active engagement, helping ensure that each step is acknowledged, understood, and verified by the whole team.

 

Research has shown significant reductions in complications and mortality after the checklist has been implemented. 

 

But success depends on how it is used - not just if it’s used.

 

And this is where video-based observation becomes a powerful tool.

 

Using Codimg Video Analysis Software to Strengthen Checklist Compliance

Software for video-based observation, such as Codimg, can be used to systematically review the surgical team’s performance in the theatre and provide objective evidence on how well the checklist was implemented.

 

Video observation can be applied to both real world surgeries or simulated scenarios and, as such, can be a powerful tool for professional development.

 

Let’s take a closer look at some of the benefits.

1. Objective Data

The basis of observation with Codimg is the digital template. This is a fully customisable set of buttons which can be used to “tag” a video of the surgical procedure.

 

Every aspect of the surgical safety checklist can be added to the digital template in the form of a button. When a button is clicked, it creates a short video clip which contains objective evidence that this phase has been completed correctly.

 

For example, in the Time Out phase of the surgery, you can have buttons such as “Confirm Patient”, “Confirm Site” and “Confirm Procedure”. When the observer sees these things, they simply click the button to evidence that these things have been done, or not.

 

Each surgical procedure can be filmed and then tagged in real time or post-procedure to measure:

 

• Was the checklist completed?
• Was it rushed?
• Were all team members engaged?
• Did anyone speak up with concerns?

 

This transforms checklist adherence from subjective opinion to objective data.

 

This example digital template can be downloaded free from our website and used in your own observation or adapted to the specific needs of your institution:

 

 

2. Measure the Quality of Communication

Beyond the simple checking of a box, Codimg allows for:

 

• Duration analysis (How long did the Time Out last?)
• Interaction mapping (Who spoke? Who didn’t?)
• Identification of interruptions
• Detection of skipped steps

 

This helps hospital leadership understand whether the checklist is a meaningful safety pause or a superficial ritual.

 

The transcription tool in Codimg (coming soon) is perfect for this type of communication analysis. It shows exactly what was said and by whom and, in addition, the transcription is connected directly to the video so you can easily see the context of the communication.

3. Real-World and Simulation Debriefs

Video-supported debriefing is one of the most effective learning tools available, for both professional development and healthcare students.

 

By reviewing real footage:

 

• Teams can see gaps in procedure or communication
• Junior staff can reflect on speaking confidence
• Leaders can evaluate psychological safety
• Good practice can be highlighted and shared

 

Just as athletes improve by reviewing performance clips, surgical teams improve by reviewing teamwork behaviors.

 

With Codimg, it’s a simple process to filter collected video clips and data to get the most relevant information to show in debriefings. Professional video presentations for feedback sessions can be created, exported and shared in a matter of seconds.

 

 

 

4. Continuous Quality Improvement

With a range of video observation tools, Codimg provides all the tools needed to:

 

• Track performance and trends over time
• Create benchmark comparisons between institutions and departments
• Obtain audit-ready documentation and evidence for accreditation and governance
• Improve patient safety and save lives

 

Instead of relying on checklist forms alone, hospitals gain behavioural insight.

 

Solutions in the Codimg range include Premium (desktop software), View (live observation) and Hub (online observation, tracking and sharing).

 

Moving from Compliance to Culture

The WHO Surgical Safety Checklist was never meant to be a simple piece of paperwork.

 

It was designed to reshape surgical culture. To slow teams down at critical moments and create shared awareness.

 

Video analysis tools like Codimg help answer key questions:

 

• Is the checklist improving communication?
• Are teams truly engaging?
• Where are the breakdowns?
• What does excellence look like?

 

When paired together, the checklist and structured video review create a powerful safety loop:

 

Perform → Film → Observe → Reflect → Improve

Conclusion

The WHO Surgical Safety Checklist provides the structure for ensuring communication and safety is given top priority.

At the same time, video analysis provides the tools and insight to ensure the correct implementation of the list, going far beyond what can be done with just paper and a pen.

 

Together, they turn a simple checklist into a living system for improving performance and ensuring the safety of patients.

 

If you are interested in the use of video-based observation at your hospital or training centre, please do not hesitate to get in contact with us.

 

One of our experts will talk through your needs and tailor a specific observation solution for your institution. They will also set you up with a free trial of the software so you can see the utility for yourself.

 

Until then…

 

Thanks for reading.