THE TEST Back in Boston, I set my research team to work making our fledgling surgery checklist more usable. We tried to follow the lessons from aviation. We made it clearer. We made it speedier. We adopted mainly a DO-CONFIRM rather than a READ-DO format, to give people greater flexibility in performing their tasks while nonetheless having them stop at key points to confirm that critical steps have not been overlooked. The checklist emerged vastly improved. Next, we tested it in a simulator, otherwise known as the conference room on my hallway at the school of public health where I do research. We had an assistant lie on a table. She was our patient. We assigned different people to play the part of the surgeon, the surgical assistant, the nurses (one scrubbed-in and one circulating), and the anesthesiologist. But we hit problems just trying to get started. Who, for example, was supposed to bring things to a halt and kick off the checklist? We’d been vague about that, but it proved no small decision.
