Abstract
BackgroundEven though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance. In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO’s Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators.MethodsGrounded theory was used in gathering and analyzing data from observations of the checklist used in the operating room, in conjunction with single and focus group interviews. A purposeful sample of 14 nurse-anesthetists and operating room nurses as surgical team members in a tertiary teaching hospital participated in the study.ResultsThe nurses’ main concern regarding checklist utilization was identified as “how to obtain professional and social acceptance within the team”. The emergent grounded theory of “adjusting team involvement” consisted of three strategies; distancing, moderating and engaging team involvement. The use of these strategies explains how they resolved their challenges. Each strategy had corresponding conditions and consequences, determining checklist compliance, and how the checklist was used.ConclusionEven though nurses seem to have a loyal attitude towards the WHO’s checklist regarding their task work, they adjusted their surgical team involvement according to practical, social and professional conditions in their work environment. This might have resulted in the incomplete use of the checklist and therefore a low compliance rate. Findings also emphasized the importance of: a) management support when implementing WHO’s Safe Surgical Checklist, and b) interprofessional education approach to local adaptation of the checklists use.
Highlights
Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance
Providing healthcare is inherently interdisciplinary, involving physicians, nurses and allied health professionals from different specialties. It is widely recognized in patient safety literature that team performance is crucial in providing safe patient care [1] and that many of the factors contributing to adverse events in healthcare, originate from flawed teamwork, rather than from lack of clinical skills [2,3]
There is an ongoing debate in leading medical journals as to whether a technical solution such as the checklist really can contribute to safer patient care, whilst effective teamwork per se is more crucial to providing safe patient care, and teamwork must be distinguished from task work [8]
Summary
Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO’s Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators. Providing healthcare is inherently interdisciplinary, involving physicians, nurses and allied health professionals from different specialties It is widely recognized in patient safety literature that team performance is crucial in providing safe patient care [1] and that many of the factors contributing to adverse events in healthcare, originate from flawed teamwork, rather than from lack of clinical skills [2,3]. According to the WHO’s implementation manual, the checklist provides a tool for two purposes: enabling consistency in safety for patients, and introducing and maintaining a culture that values achieving it [7]
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