Checklists are a powerful tool to prevent accidents; but they're not the final solution. Education and training are also important to implement and evolve safety practices, but an effective intervention solution must approach the problem systematically.
The Hierarchy of Intervention Effectiveness, first introduced in 1999 by the Institute for Safe Medication Practices, presents a risk management theory that ranks intervention methods from least to most effective. Human-focused interventions such as education, training, rules, policies, and checklists are rated toward the bottom of its scale. While not without value, these interventions are less reliable than system-focused interventions such as standardization and computerization. The most highly ranked intervention measures are forcing functions and constraints as they directly prevent the user from making a mistake, thus making them the most powerful and effective error prevention tools. Classic examples of forcing functions include a user being prevented from starting a car while it is in gear; or a user being prevented from starting a microwave with the door open.
An evaluation of 487 orthopedic surgery procedures with the StartBox System identified 17 near miss events that could have led to the occurrence of a wrong-site surgery. The use of the System resulted in the occurrence of zero wrong site surgeries.