Creating Safe Environments on Surgical Missions

By: Trevor Hebenstreit, Program Officer 

January 9, 2015

Although surgical care can prevent loss of life or limb, if unsafe, it can also present a considerable risk of complication and death. In fact, unsafe surgery causes an estimated one million deaths and seven million complications each year.

Data suggests that at least half of all surgical complications are avoidable. The World Health Organization has undertaken a number of global and regional initiatives to address this concern. One of the initiatives being the Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care. The World Alliance for Patient Safety initiated work on this Challenge in January 2007. 

The focus of the Challenge was the WHO Safe Surgery Checklist. The checklist was completed in 2008 and identified three phases of an operation, each corresponding to a specific period in the normal flow of work: before the induction of anesthesia (“sign in”), before the incision of the skin (“time out”) and before the patient leaves the operating room (“sign out”). In each phase, a checklist coordinator must confirm that the surgery team has completed the listed tasks before it proceeds with the operation.

In 2009 Operation Smile’s Quality Assurance team launched the use of the WHO surgical safety checklist on our medical missions and it has been utilized ever since. The surgical safety checklist has not only influenced the way that we run our surgical programs, but it has also influenced the hospitals that we partner with. In a recent trip to the Philippines I experienced this firsthand. I was conducting a pre-mission hospital assessment and while I was in the operating room I noticed that the surgical safety checklist was on the wall. I asked the head nurse when they started using this and she smiled and said that the hospital adopted the tool after they saw Operation Smile using it on one of our past missions. She expressed how it has greatly reduced the number of incidents that were occurring and that their hospital had even recommended it to other hospitals in the surrounding area. Operation Smile continues to work to find ways to help partner institutions increase the safety of the surgical care that they deliver. 


"WHO Surgical Safety Checklist and Implementation Manual." Patient Safety. N.p., 2008. Web. Winter 2014.

"A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population." The New England Journal of Medicine (2009): 49-499. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. Alex B. Haynes, M.D., M.P.H., Thomas G. Weiser, M.D., M.P.H., William R. Berry, M.D., M.P.H., Stuart R. Lipsitz, Sc.D., Abdel-Hadi S. Breizat, M.D., Ph.D., E. Patchen Dellinger, M.D., Teodoro Herbosa, M.D., Sudhir Joseph, M.S., Pascience L. Kibatala, M.D., Marie Carmela M. Lapitan, M.D., Alan F. Merry, M.B., Ch.B., F.A.N.Z.C.A., F.R.C.A., Krishna Moorthy, M.D., F.R.C.S., Richard K. Reznick, M.D., M.Ed., Bryce Taylor, M.D., and Atul A. Gawande, M.D., M.P.H. for the Safe Surgery Saves Lives Study Group, 29 Jan. 2009. Web. 19 Dec. 2014.



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