Explore a checklist intervention for neurosurgery


  • Design research

  • Process visualization and strategy maps

  • Information design and prototyping


  • Analysis of sterile checklist delivery pathways enabled team to consider workflow and systems issues

  • Optimized prototypes were developed for trial and evaluation by health innovation research team


The World Health Organization (WHO) Surgical Safety Checklist had been integrated into the workflow at [confidential] hospital. However, there were a few types of surgeries for which the checklist did not work as well.

The client wanted to explore how a procedure-specific or device-specific checklist could be integrated with the main surgical safety checklist, and evaluate whether the addition could make patients more safe. Research indicated that ventriculoperitoneal shunt surgery was associated with a high complication risk due to mechanical issues and infection.

The procedure itself was straightforward and involved a dedicated device cart, so the VP shunt procedure was identified as a target candidate to test the innovation.

How we helped

First, we conducted research to explore and document the physical environment of the neurosurgery suites, map surgical workflow, assess delivery and deployment options, and evaluate options for managing sterility.

We worked with the team to explore differences between procedure-specific checklists and device-specific checklists, and mapped strategies for ensuring how the right checklist would get to the right operating room at the right time. We then helped refine content for the VP shunt checklist and developed a simple and concise design for testing.



We conducted observation in two hospitals to understand the physical environments into which the proposed solution would need to live.

Stakeholder interviews are useful, but people often overlook elements of the space in which they work. Seeing the physical limitations, the size and location of the cart and sterile bundles, and each facility's existing surgical safety poster help us set useful design parameters.

Visual summary of our research at two hospitals about the operating room environment for a neurosurgery checklist.

Mapping work flow

Understanding the roles of individuals on the surgical team and identifying natural pauses in their workflow was important for determining when and how the checklist could be delivered. 

Prioritizing information 

Working from early prototypes the team had developed, we analyzed component information and streamlined the checklist content and presentation.

Visualizing options

One puzzle was determining whether the checklist needed to be sterile when used in the operating room. If so, how could sterility be ensured along it's pathway to the surgical team? And how could the checklist be deployed in the right OR at the right time?

On-site research: shunt cart outside operating room.

Exploring implications

By visualizing options and key questions, we were able to help the team consider what had been learned and evaluate the pros and cons of different approaches.