The key point here is that a potentially valuable innovation such as the surgical checklist ought to be introduced similar to the Scottish experience (as described above): with clinical and administrative leadership, monitoring and support. As was clearly pointed out at Taming of the Queue 2014, Canadian health administration talks while the Scottish acts on matters of public system effectiveness.

Evaluation of checklist effectiveness (a subset of quality) in diverse surgical settings should be part of routine quality assurance in our publicly funded hospitals.

If the checklist was deemed important enough to be mandated then it follows that its use must be evaluated.

While the Urbach study has its flaws and detractors (including Dr. Atul Gawande) the health policy direction should be clear: evaluate the value across the broad surgical case mix. The question that remains is where does the authority lie to move in such a direction in all provinces and territories?