BMJ Qual Saf 21:617-620 doi:10.1136/bmjqs-2011-000608
  • Viewpoint

Checklists, safety, my culture and me

  1. Karthik Raghunathan
  1. Correspondence to Dr Karthik Raghunathan, Department of Anaesthesiology, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA; karthik.raghunathan{at}
  1. Contributors KR is the sole contributor to this manuscript.

  • Accepted 1 March 2012
  • Published Online First 4 April 2012


The world is not flat. Hierarchy is a fact of life in society and in healthcare institutions. National, specialty-specific and institutional cultures may play an important role in shaping today's patient -safety climate. The influence of power distance on safety interventions is under-studied. Checklists may make power distance-hampered negotiations easier by providing a standardised aviation-like framework for communications and by democratising the environment. By using surveys and simulation, we might discover patterns of potentially hidden yet problematic interactions that might foster maintenance of the error swamp. We need to understand how people interact as members of a group as this is crucial for the development of generalisable safety interventions.


  • Linked article 000283.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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