Our institution participated in the multicenter international landmark trial under the leadership of Dr. E. Patchen Dellinger and subsequently implemented in 2008, a 4-part surgical safety checklist resembling the World Health Organization checklist. The version of the surgical safety checklist implemented in our institution was developed by the Surgical Care and Outcomes Assessment Program (SCOAP), a physician-led program to improve surgical care in Washington state.

The SCOAP surgical safety checklist was displayed as a wall poster in all of our operating rooms and considerable educational efforts were made to encourage the use of the checklists. While the SCOAP surgical safety checklists were widely used in our institution, our experience showed that in many instances checklists were not performed as intended. One of the more significant flaws in the conduct of the SCOAP checklists was that the wall posters displaying the checklists were not easily visible to the entire surgical team, and checklist items were often skipped. We believed that a more effective method of performing the SCOAP surgical safety checklists was needed.

The natural place to look for checklist design guidance is aviation given the deep experience with checklist design and implementation in the aviation industry. There is also evidence from the aviation industry that computerized checklists perform better than paper checklists by preventing skipped items and by enhancing readability and visibility.​