One of the issues I've seen in implementing checklists is actually the urge of people to put extreme detail into the checklist and people not putting items in a

One of the issues I've seen in implementing checklists is actually the urge of people to put extreme detail into the checklist and people not putting items in a reasonable order. If you look at the referenced checklist (https://apps.who.int/iris/bitstream/handle/10665/44186/9789241598590_eng_Checklist.pdf https://apps.who.int/iris/bitstream/handle/10665/44186/97892...) it is a very approachable list that acknowledges good skill in the people involved. Note that the "before patient leaves" checklist mentions the sponge count but the pre-incision checklist does not. That's because a sponge count is simply part of the job of an instrument nurse and something they always do when they open a pack of sponges. It's also hard to insert checklists into established procedures. One thing you could do is attach them to important parts that are not allowed to be used until you read the checklist. For example, you could refuse to unwrap the main surgical pack until the pre-incision checklist is followed. Pharmacy could wrap the anesthetic induction drug in the first checklist. The surgeon could be responsible for signing the final checklist in order to get paid. Keep checklists simple, use them every time. Put them in places where they have to be used.