Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical safety checklist

Abstract

BackgroundThe surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Although mandated in many health care institutions around the world, challenges in implementation of the SSC continue.To use Normalisation Process Theory (NPT) to help understand how/why implementation of a complex intervention coined Pass The Baton (PTB) could help explain what facets of the Surgical Safety Checklist use led to its’ integration in practice, while others were not.MethodsA longitudinal multi-method study using survey and interviews was undertaken. Implementation of PTB involved; change champions, audit and feedback, education and prompts. Following implementation, surgical teams were surveyed using the NOrmalization MeAsure Development (NoMAD) and subsequently interviewed to explore the impact of PTB on their use of the checklist at 6 and 12 months respectively. Respondents’ self-reported perceptions of implementation of PTB was explained using the four NPT constructs; coherence, cognitive participation, collective action, and reflexive monitoring. Survey data were analysed using descriptive statistics. Interview data were coded inductively and content analysed using a framework derived from NPT.ResultsThe NoMAD survey response rate was 59/150 (39.3%). Many (45/59, 77.6%) survey respondents saw the value in PTB, while 50/59 (86.2%) would continue to use it; 45/59 (77.6%) believed that PTB could easily be integrated into existing workflows, and 48/59 (82.8%) thought that feedback could improve PTB in the future.A total of 8 interviews were completed with 26 surgical team members. Nurses and physicians held mixed views towards coherence while buy-in and participation relied on individuals’ investment in the implementation process and the ability to modify PTB. Participants generally recognised the benefit and value of using PTB in the ongoing implementation the checklist.ConclusionsWorkarounds and flexible co-construction in implementation designed to improve team communications in surgery may facilitate their normalisation in practice.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2973-5) contains supplementary material, which is available to authorized users.

Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

“…Gask et al [ 70 ] Normalisation Process Model To inform the process of implementation of collaborative care and provide a framework to guide analysis United Kingdom Primary Care 28. Gillespie et al [ 71 ] Normalisation Process Theory To provide an explanatory model to explore and evaluate the implementation of a complex intervention in the Operating Room (OR) context Australia Primary Care 29. Glynn et al [ 72 ] Normalisation Process Theory To conduct a theoretically informed analysis, using NPT, of the potential barriers and levers to the implementation of a health intervention to promote physical activity in primary care Ireland Primary Care 30.…”

“…The most common benefit reported from the use of sustainability approaches was the improved understanding of sustainability and sustainability constructs. Twenty-five articles stated they were able to improve conceptualisation of sustainability of interventions [ 47 , 48 , 50 , 53 , 54 , 58 , 61 , 71 – 73 , 75 , 78 – 80 , 86 , 88 , 92 , 95 , 96 , 100 , 101 , 103 , 104 , 110 ]. For example, Deconinck et al applied Atun’s Conceptual Framework for Analysing Integration of Targeted Health Interventions, and found that the approach provided a systems lens that increased understanding of pathways for integration to help sustain coverage of effective interventions [ 58 , 120 ].…”

“…For example, users found difficulty in discerning the differences between the constructs within the NPT, which were often reported to overlap in content and concept. Both Drew et al and Gillespie et al found that the overlapping nature of the four constructs within the NPT meant the data could be coded into more than one construct [62,71]. Another noted issue was the inability of constructs within approaches to cover all the relevant areas needed for studies [82,104,109].…”

Evaluation of a patient safety programme on Surgical Safety Checklist Compliance: a prospective longitudinal study

“…The PTB programme was co-constructed with stakeholders, 21 and ‘normalised’ in everyday practice over time. 38 The implementation team included credible leaders from nursing and surgery, which contributed to its sustainability and spread. Following evaluation of the PTB programme at this facility, the programme was implemented at two smaller satellite hospitals within the health services district.…”

Avaliação da adesão ao checklist de cirurgia segura em um hospital universitário

“…As implicações associadas aos procedimentos cirúrgicos são constantes e representam, mundialmente, um problema de saúde. [1][2] Um a cada trezentos pacientes admitidos nos hospitais morre e, em mais de 50%, a causa da morte está relacionada a eventos adversos cirúrgicos evitáveis. 3 No Brasil, ainda há poucos dados, mas os existentes são alarmantes.…”