How to Salvage a Useful Process That Isn’t Working Anymore

Inside Singapore General Hospital’s successful effort to redesign and reimplement a longstanding surgical checklist.

It is a familiar story in health care and many other settings: the performance of an innovative process deteriorates over time. Instead of automatically discarding it, organizations should understand the causes. They may then decide to redesign and reimplement the process. Using the reimplementation of a surgical checklist at Singapore General Hospital as an example, this article explains how to conduct a reimplementation.

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  Rachel Moyal-Smith is an implementation scientist and health systems researcher at Ariadne Labs, a joint center for health systems innovation at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.
  

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  Kaisin Yee manages health systems strengthening and innovation strategy at SingHealth Duke-NUS Global Health Institute and Singapore’s MOH Office for Healthcare Transformation.
  

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  Mary Brindle, MD, is the director of the safe surgery and safe systems program at Ariadne Labs, a joint center for health systems innovation at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital. She is also a pediatric surgeon at Alberta Children’s Hospital and a professor of surgery and community health  sciences at the University of Calgary’s Cumming School of Medicine.
  

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