Setting the quality objectives for a health and wellbeing organisation requires a focus on patient safety.

There is no panacea for quality. The recent move to quality accounts and patient reported outcomes is welcome, but the process of care matters too.

Reading recent editorials, I have been struck by one development - a consensus on the most significant advance in healthcare for 2009. Usually predicting the most important pharmaceutical, technological or genetics breakthroughs for the coming year would be a tough call. But this is one I would safely call (even in today's climate) a banker. This idea - the surgical safety checklist - will transform surgical practice, not through computers, titanium alloys or human endeavour, but by a single sheet of paper.

This sheet of paper also unlocks the door to another of medicine's greatest challenges - clinical leadership. Leaders can be found in all parts of the health system, but getting them to agree is usually close to impossible. All clinicians recognise the joke about putting 100 of us in a room and getting 101 solutions. The trouble is we all believe we are right. The tricky part comes in proving otherwise.

Surgical safety checklist

The National Patient Safety Agency issued an alert in January requiring all healthcare organisations to implement the World Health Organisation's surgical safety checklist for every patient undergoing a surgical procedure.

This follows dramatic results from a one year global pilot, which included St Mary's Hospital in London. The tool is perhaps an all too rare example of what can be achieved when doctors, nurses, theatre staff and quality improvement leaders get together.

The surgical safety checklist aims to reduce the number of errors and complications resulting from surgery. It outlines essential standards of surgical care and is designed to be simple, widely applicable and address common and potentially disastrous lapses. The accepted surgical mortality rate for theatre ranges from 0.4 to 0.8 per cent, with a 3-16 per cent complication rate. The results have been amazing, with surgical deaths and complications reduced by one third when the checklist is used.

All providers in the UK are required to implement the checklist by 2010. As group medical director for a large charitable independent provider, you might be wondering about my position. The answer is simple: interim results from the checklist were so impressive that we signed up to the WHO initiative and amended our policy last July.

For healthcare to be smart, we must all ensure everyone is in safe hands.

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