The Gap between Individual Perception and Compliance: A Qualitative Follow-Up Study of the Surgical Safety Checklist Application

Abstract

Background“The Surgical Safety Checklist (SSC) is important, but we don’t use it adequately” is a well-suited statement that reflects the SSC's application in hospitals. Our aim was to follow up on our initial study on compliance (2014) by analysing differences between individual perception and compliance with the SSC.MethodsWe conducted a follow-up online survey to assess healthcare professionals’ individual perception of, as well as satisfaction and compliance with the SSC three years following its thorough implementation.Results171 (19.5%) of 875 operating team members completed the online survey. 99.4% confirmed using the SSC. Self-estimated subjective knowledge about the intention of the checklist was high, whereas objective knowledge was moderate, but improved as compared to 2014. According to an independent audit the SSC was used in 93.1% of all operations and among the SSCs used the completion rate was 57.2%. The use of the SSC was rated as rather easy [median (IQR): 7 (6–7)], familiar [7 (6–7)], generally important [7 (7–7)], and good for patients [7 (6–7)] as well as for employees [7 (7–7)]. Only comfort of use was rated lower [6 (5–7)].ConclusionThere is a gap between individual perception and actual application of the SSC. Despite healthcare professionals confirming the importance of the SSC, compliance was moderate. The introduction of SSCs in the health care sector remains a constant challenge and requires continuous re-evaluation as well as a sensible integration into existing workflows in hospitals.

Reality check of using the surgical safety checklist: A qualitative study to observe application errors during snapshot audits

“…In general, if guidelines are properly applied as intended can be either evaluated using a quantitative approach (paper-based audits) or through a qualitative approach such as using the method of direct observations (snapshot audits) [ 10 , 11 , 18 ]. In order to perform snapshot audits a checklist for observers is needed.…”

“…The circulating nurse as the designated checklist coordinator has to guide the team throughout all questions and to tick the corresponding checkboxes. The checklist coordinator only ticks the checkbox if an answer was given to the corresponding question [ 10 , 11 ]. Both observers were trained to review the SSC application in practice according to the requirements as stated by the WHO [ 19 ].…”

“…Barriers to proper SSC application also included insufficient instruction prior its implementation, perceived redundancy of collected data and poor team culture [ 17 ]. Our hospital performs approximately 47,000 surgical procedures in 44 operating theatres each year and a previous in-house survey among healthcare professionals revealed a high level of perceived usefulness of the SSC, while compliance rates, assessed by paper-based audits, remained low [ 10 , 11 ]. These audits were performed by independent observers on two defined days by collection and review of paper-based hospital-wide SSCs.…”

“…These audits were performed by independent observers on two defined days by collection and review of paper-based hospital-wide SSCs. According to these audits, SSCs were used in 93.1% of all operations; however, just 57.2% were completed [ 11 ]. The approach of collecting quantitative data through audits is one possible approach to check SSC compliance, but how is the SSC used in reality?…”

“…In a previous publication snaphot audits were introduced as a method to gain further insight into the application of patient-safety relevant topics in daily clinical practice (eg. on wards or the OR) [ 11 , 18 ]. The aim of the present study was to apply the methodology of snapshot audits with incorporated feedback sessions for evaluating surgical teams in two successive years.…”