Anne van Dalen

General Introduction I 19 tailored to conditions and experience within organisations. 50 52 It has now evolved from a focus on behaviour change to one dealing with more specific aviation concepts such as team building, briefing strategies, situation awareness, stress management, and decision making. 31 These training skills were adapted for acute medical care and the term crisis resource management was introduced. 31,53 Simulation-based CRM training has now become routine in anaesthesia, emergency medicine, critical care, as well as obstetrics and gynaecology. 54,55 Surgical safety checklist Substantial data exist regarding the impact of improvinghuman factor skills, for example by using checklists, briefings and debriefings, coaching and simulation training. 46,56-58 Yet, the best way to go about improving the team’s performance remains open for discussion. 59,60 Moreover, it appears that safety improvement initiatives are not easily sustained. 17,61 In 2007, WHO Patient Safety launched the Second Global Patient Safety Challenge, Safe Surgery Saves Lives, to improve surgical safety globally. 62 Anaesthesiologists, operating nurses, surgeons, safety experts, patients, and other professionals came together to develop a solution to the problem of unsafe surgery and introduced the WHO Surgical Safety Checklist. 63,64 As explained by the WHO, ‘the WHO Surgical Safety Checklist (see Figure 3) is a simple tool to improve the safety of surgical procedures by bringing together the whole operating team (surgeons, anaesthesia providers and nurses) to perform key safety checks during vital phases of perioperative care: prior to the induction of anaesthesia, prior to skin incision and before the team leaves the operating room.’ 62 The first results concerning the use of this checklist in eight hospitals around the world was associated with a reduction in major complications from 11.0% before introductionof thechecklist to7.0%afterward. 65 Thisawarenesshas ledtothedevelopment of the Surgical Patient Safety System (SURPASS) checklist, which was tested in six Dutch teaching and academic hospitals. Its use was associated with a reduction in the postoperative complication rate from 27.3 per 100 patients before implementation to 16.7 per 100 afterward and a reduction in in-hospital mortality from 1.5 to 0.8%. 66