How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties in Norway

Abstract

Background The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staffʼs perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored – yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisiplinary perioperative team integrate the SSC within their risk management strategies. Methods An ethnographic case study including observations (40h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. Results We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSCʼs practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. Conclusion When the SSC is not integrated within existing risk management strategies, but perceived as an “add on”, its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.

Unlocking Insights: Exploring Knowledge and Attitudes on the WHO Surgical Safety Checklist among Operating Room Personnel in Police and Services Hospital, Peshawar, Pakistan

“…This broader spectrum of patient safety is addressed by the Surgical Patient Safety System (SURPASS), which, despite its comprehensive coverage from admission to discharge, places a less pronounced emphasis on specific intraoperative issues, such as difficult airway management or significant blood loss, yet includes key elements like team introductions and readiness for unforeseen events (6,7). The utility of the SSC extends into identifying issues and delineating responsibilities for resolution, necessitating a collective approach among surgeons, anesthesiologists, and nurses to address highlighted concerns, such as delays in administering appropriate antibiotics, before proceeding (8). Despite the demonstrated success of the SSC in reducing mortality and morbidity in surgical interventions, its adoption, particularly in low-and middle-income countries, remains a concern.…”