Surgical Teams’ Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years

Urban, Denisa; Burian, Barbara K.; Patel, Kamlesh; Turley, Nathan; Elam, Meagan; MacRobie, Ali; Merry, Alan; Kumar, Manoj; Hannenberg, Alexander A.; Haynes, Alex B.; Brindle, Mary

doi:10.1097/as9.0000000000000075

Cited by 11 publications

(18 citation statements)

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“…This qualitative study supports a larger parent study aimed at developing a toolkit to facilitate SSC adaptation, implementation, and utilization in high-income settings [ 25 ]. The current study utilized interviews with surgical team members and health administrators to create a comprehensive understanding of the key elements necessary for successful implementation of the SSC.…”

Section: Methodssupporting

confidence: 72%

“…Interviews were conducted across five high-income countries: the United States ( n = 9), Canada ( n = 11), the United Kingdom ( n = 7), Australia ( n = 12), and New Zealand ( n = 12). These countries were selected because of their similar resource availability, differing degrees of checklist utilization [ 25 ], and opportunity to examine how healthcare delivery systems may impact implementation and use of the SSC. Surgical team members included clinicians from surgery, nursing, and anesthesiology.…”

Section: Methodsmentioning

confidence: 99%

“…Interviewees were initially recruited through purposive sampling [ 26 ] of respondents to a survey conducted through the parent study that examined current attitudes toward SSC use in high-income countries [ 25 ] who indicated a willingness to participate in an interview. This was followed by non-probability discriminative snowball sampling [ 27 ]; interviewees directed us to other colleagues who may be interested in discussing their experiences with the SSC.…”

Section: Methodsmentioning

confidence: 99%

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Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study

Elam

Louis

Brindle

et al. 2022

BMC Health Serv Res

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Background Strategies selected to implement the WHO’s Surgical Safety Checklist (SSC) are key factors in its ability to improve patient safety. Underutilization of implementation frameworks for informing implementation processes hinders our understanding of the checklists’ varying effectiveness in different contexts. This study explored the extent to which SSC implementation practices could be assessed through the i-PARIHS framework and examined how it could support development of targeted recommendations to improve SSC implementation in high-income settings. Methods This qualitative study utilized interviews with surgical team members and health administrators from five high-income countries to understand the key elements necessary for successful implementation of the SSC. Using thematic analysis, we identified within and across-case themes that were mapped to the i-PARIHS framework constructs. Gaps in current implementation strategies were identified, and the utility of i-PARIHS to guide future efforts was assessed. Results Fifty-one multi-disciplinary clinicians and health administrators completed interviews. We identified themes that impacted SSC implementation in each of the four i-PARIHS constructs and several that spanned multiple constructs. Within innovation, a disconnect between the clinical outcomes-focused evidence in the literature and interviewees’ patient-safety focus on observable results reduced the SSC’s perceived relevance. Within recipients, existing surgical team hierarchies impacted checklist engagement, but this could be addressed through a shared leadership model. Within context, organizational priorities resulting in time pressures on surgical teams were at odds with SSC patient safety goals and reduced fidelity. At a health system level, employing surgical team members through the state or health region resulted in significant challenges in enforcing checklist use in private vs public hospitals. Within its facilitation construct, i-PARIHS includes limited definitions of facilitation processes. We identified using multiple interdisciplinary champions; establishing checklist performance feedback mechanisms; and modifying checklist processes, such as implementing a full-team huddle, as facilitators of successful SSC implementation. Conclusion The i-PARIHS framework enabled a comprehensive assessment of current implementation strategies, identifying key gaps and allowed for recommending targeted improvements. i-PARIHS could serve as a guide for planning future SSC implementation efforts, however, further clarification of facilitation processes would improve the framework’s utility. Trial registration No health care intervention was performed.

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Section: Methodssupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study

Elam

Louis

Brindle

et al. 2022

BMC Health Serv Res

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“…To assess the surgical staff's perceptions of the checklist, we developed a survey derived from a previously published international survey tool 7 . The purpose of the survey was to provide more insight into the current use of the checklist and solicit recommendations for improvement.…”

Section: Methodsmentioning

confidence: 99%

Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Moyal‐Smith

Etheridge

Lim

et al. 2022

Evaluation Clinical Practice

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Rationale, Aims, and Objectives: The WHO Surgical Safety Checklist is a communication tool designed to improve surgical safety processes and enhance teamwork. It has been widely adopted since its introduction over ten years ago.As surgical safety needs evolve, organizations should periodically review and update their checklists. A holistic evaluation of the checklist in the context of an organization is the first step to making informed updates. In this article, we describe a comprehensive but feasible strategy for checklist evaluation which we developed and implemented as part of a surgical safety initiative in a high-performing center.Methods: A three-part evaluation plan was developed and carried out by a multidisciplinary team. The evaluation included assessment of 1. Quality of care through a review of surgical safety events; 2. Safety culture through a validated survey and informal feedback; and 3. Checklist performance through direct observations and a staff survey. To prepare for re-implementation the current institutional checklist was critically evaluated and a context assessment survey was administered to surgical staff. Results:The evaluation revealed challenges in communication and teamwork, with surgical staff often perceived to be working in silos. The quality of care assessment indicated room for improvement in safety processes. Deficiencies in the safety culture measures of communication and feedback shed light on an overall lack of engagement with the checklist. Checklist performance demonstrated good adherence to the items on the checklist but limited engagement by the surgical team and minimal communication between subteams. These findings informed our revisions to the checklist and its implementation processes. Conclusions:We developed and implemented a comprehensive, scalable approach to checklist evaluation which directly informed improvements to the checklist that were tailored to the organization's current context. Organizations can apply this framework to breathe new life into their checklist and transform their safety culture.

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“…Det er også viktig at operasjonssykepleier er i forkant av det som skal skje i operasjonen for å kunne støtte kirurgen slik at resultatet av operasjonen blir best mulig for pasienten (10,20). Studier viser at sjekklista Trygg kirurgi både bidrar til bedre kommunikasjon og teamarbeid på operasjonsstua (21,22).…”

Section: Trivsel God Kommunikasjon Og Samarbeid Fremmer Teamarbeidet ...unclassified

Fremmende kirurgisk teamarbeid- en kvalitativ studie av operasjonssykepleieres erfaringer og oppfatninger

Kaldråstøyl

Bohman

Salemonsen

et al. 2022

inspira

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Bakgrunn: Operasjonssykepleiere arbeider sammen med anestesisykepleiere, anestesileger og kirurger i det kirurgiske team. Dårlig kommunikasjonen mellom teammedlemmene, manglende respekt og liten arbeidserfaring påvirker teamarbeidet negativt. Det mangler kunnskap om hva som fremmer et godt kirurgisk teamarbeid. Det er derfor behov for mer kunnskap om hvilke erfaringer og oppfatninger operasjonssykepleiere har om hva som er fremmende for teamarbeidet på operasjonsstua. Hensikt: Å få mer kunnskap om hvordan operasjonssykepleiere erfarer og oppfatter det å arbeide i det kirurgiske team, og belyse hva som kan fremme teamarbeidet. Metode: Studien har et utforskende og beskrivende kvalitativt design. Åtte semistrukturerte individuelle intervju med operasjonssykepleiere fra to sykehus i Helse Vest ble gjennomført i februar 2021. Kvalitativ innholdsanalyse ble benyttet i dataanalysen. Resultater: I analysen kom det frem fire kategorier: betydningen av en god tone og trivsel på operasjonsstua, pasienten i fokus, lydhør og tydelig ledelse, og trygghet i yrkesrollen. I kategorien betydningen av en god tone og trivsel på operasjonsstua ble det identifisert tre underkategorier: god og tydelig kommunikasjon, respekt og likeverd, og ulike personligheter i et team. Konklusjon: Operasjonssykepleierne erfarte at god kommunikasjon mellom medlemmene i det kirurgiske team var avgjørende for et godt teamarbeid. Respekt og likeverd skapte en god tone og gjorde det lettere å stille spørsmål og ha konstruktiv kommunikasjon. Personlige egenskaper, en støttende ledelse og trygghet i yrkesrollen var viktig for et godt teamarbeid. Felles teamtrening med alle profesjonene i teamet vil kunne bidra til å utvikle gode ikke-tekniske ferdigheter. ENGLISH ABSTRACT Promoting teamwork in the operating theatre—a qualitative study of operating room nurses’ experiences and perceptions Background: The surgical team consists of operating room nurses, anesthesia nurses, surgeons, and anesthetists. Research shows that collaboration within the interdisciplinary surgical team in the operating theatre can be a challenge and may influence the teamwork negatively. Aim: To gain more knowledge about what operating room nurses’ experience as important to promote surgical teamwork. Methods: The study had a qualitative design with eight semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Operating room nurses experiences of promoting surgical teamwork were categorized in four main categories: (1) the meaning of a good atmosphere in the operating theatre, (2) the patient in focus, (3) sensitive and clear leadership, and (4) confidence in the professional role. Conclusion: Achieving sufficient communication in the multidisciplinary surgical team is crucial to enhance the quality of the teamwork and patient safety. Promoting teamwork is complex, and personal characteristics, supportive leadership, and confidence in the professional role are significant aspects. To maintain a pleasant atmosphere in the operating theatre, respect and equality between the members of the team is essential. Joint team training may contribute to the development of non-technical skills within the surgical team.

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Surgical Teams’ Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 60 publications

Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study

Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study

Creating a high‐performance surgical safety checklist: A multimodal evaluation plan to reinvigorate the checklist

Fremmende kirurgisk teamarbeid- en kvalitativ studie av operasjonssykepleieres erfaringer og oppfatninger

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