Checking on the safety checklist

A simple safety checklist before surgery saved lives in operating rooms around the world, this Globe story reported earlier this week. That spurred a simple question.

"What does it take?" Beth Israel Deaconess CEO Paul Levy asks on his blog Running a Hospital. Why aren't hospitals adopting the checklist Dr. Atul Gawande of Brigham and Women's Hospital has now shown cuts complications by a third?

About 30 commenters offer answers, from hospital politics to egos to time pressures. Dr. Don Berwick of the Institute for Healthcare Improvement says this:

"As 'duh' as the checklist looks (and it's really 'duh'), this is still a 'good people - bad system' thing, mostly," Berwick writes.

And Gawande himself joins the discussion:

"The intervention is simple. It is 'obvious,' " he writes. "And it is really really hard."

Levy calls the debate amazing.

"It is almost like a seminar on quality and safety improvement!" he said in an e-mail to the Globe.