"While there tends to be much more interest in technological breakthroughs and new drugs, these kinds of interventions probably have a greater potential to impact health care than any other. I am sure that we can save more lives with checklists than we can with robotics, etc."
Sundt said that the primary barrier to developing more studies like this is the difficulty in getting them published in medical journals.
While checklist studies may face obstacles in publication, doctors praised them for the obstacles they help overcome in maintaining patient safety.
"The true strength of the intervention in patient safety is demonstrated by the fact that even without 100 percent compliance and adherence to the study, there was a dramatic benefit," said Dr. David Cronin, director of liver transplantation at the Medical College of Wisconsin.
But for others, the results, when combined with compliance with the checklist, made them suspicious of the alleged benefits.
"The study is interesting, but the data and conclusions are illogical, which makes me highly distrustful of it," said Dr. Jeff Punch, chief of the division of transplantation at the University of Michigan.
Punch said that the interventions the checklist targets should not have had the effect that they did, since many of the problems they seek to prevent are quite rare.
"I am a supporter of these sorts of checklists," he said. "We use similar checklists at our hospital and I think they make things more efficient and safer, but I do not think the magnitude of the effect is large."
Dr. John D. Birkmeyer, a professor of surgery at Michigan, speculated that it was feedback, rather than the checklist itself, which aided the surgeons.
"In my opinion, the simple act of tracking outcomes and providing timely feedback to hospitals and surgeons was the most likely explanation for the important reductions in morbidity and mortality observed in this study," he said.
Unfortunately, Haynes noted, there is no way of knowing now whether the gains researchers observed in the hospitals will continue. Data collection has stopped, and while Haynes said hospitals in the study still use the checklist, they do not have numbers to confirm that surgical complications have stayed lower.
A lack of urgency, said Dr. David Euhus, a professor of surgery at the University of Texas Southwestern Medical Center, brings about the dreaded complications.
"Surgery is a complex undertaking that requires a high level of communication between everyone involved," he said. "Because it is performed so frequently and usually with excellent results we can mistakenly perceive it as 'routine.' It is never routine and exacting attention to details is always required."
For his part, Haynes remains optimistic about the future of the checklist, and emphasized the global development and potential for global use of the WHO checklist as its most important feature.
"It really speaks to the global nature of healthcare today," he said. "The issues facing healthcare practitioners are really similar in all corners of the world, rich and poor in every environment."