Impact of Perceptions of Patient Safety on Planning and Implementation of Surgical Safety Checklists

Abstract

Study ObjectiveTo assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist.DesignPopulation survey.Setting31 South Carolina hospitals implementing surgical safety checklists.PatientsSurgical team members (physicians, nurses, technicians, and administrative staff).InterventionA surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline.Measurements and Main ResultsTabled 1Comments by Type of TrainingCategoryAll (n = 165)All MD (n = 43)RN (n = 86)Tech/admin (n = 21)Other (n = 15)p∗Chi-squares and Fisher's exact test were used to determine p-valueBuy-in27 (16.4)9 (20.9)13 (15.1)0 (0.0)4 (26.7)0.04Turnover times/Time considerations22 (13.3)1 (2.3)16 (18.6)4 (19.0)1 (6.7)0.03Hospital leadership/management/administration21 (12.7)5 (11.6)10 (11.6)5 (23.8)1 (6.7)0.45Team Communication18 (10.9)2 (4.7)8 (9.3)5 (23.8)3 (20.0)0.06Quality/effectiveness of the checklist16 (9.7)11 (25.6)5 (5.8)0 (0.0)0 (0.0)0.001Other16 (9.7)3 (7.0)11 (12.8)1 (4.8)1 (6.7)0.70Influence of an individual11 (6.7)2 (4.7)8 (9.3)0 (0.0)1 (6.7)0.56No issues11 (6.7)4 (9.3)2 (2.3)2 (9.5)3 (20.0)0.03OR logistics/equipment issues10 (6.1)1 (2.3)7 (8.1)2 (9.5)0 (0.0)0.46Staffing Issues7 (4.2)1 (2.3)5 (5.8)0 (0.0)1 (6.7)0.58Freedom to speak up6 (3.6)3 (7.0)1 (1.2)2 (9.5)0 (0.0)0.09∗ Chi-squares and Fisher's exact test were used to determine p-value Open table in a new tab ConclusionIn this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures. Study ObjectiveTo assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist. To assess variation in perceptions of patient safety among surgical staff to better understand how these differences may impact planning and implementation of a surgical safety checklist. DesignPopulation survey. Population survey. Setting31 South Carolina hospitals implementing surgical safety checklists. 31 South Carolina hospitals implementing surgical safety checklists. PatientsSurgical team members (physicians, nurses, technicians, and administrative staff). Surgical team members (physicians, nurses, technicians, and administrative staff). InterventionA surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline. A surgical safety culture survey was distributed to surgical staff during implementation of surgical safety checklists. The survey included a free text section for comments and feedback. Free text comments related to patient safety were reviewed by two investigators and classified into 11 categories. In addition, these comments were classified as positive, negative, or neutral and analyzed according to self-reported professional discipline. Measurements and Main ResultsTabled 1Comments by Type of TrainingCategoryAll (n = 165)All MD (n = 43)RN (n = 86)Tech/admin (n = 21)Other (n = 15)p∗Chi-squares and Fisher's exact test were used to determine p-valueBuy-in27 (16.4)9 (20.9)13 (15.1)0 (0.0)4 (26.7)0.04Turnover times/Time considerations22 (13.3)1 (2.3)16 (18.6)4 (19.0)1 (6.7)0.03Hospital leadership/management/administration21 (12.7)5 (11.6)10 (11.6)5 (23.8)1 (6.7)0.45Team Communication18 (10.9)2 (4.7)8 (9.3)5 (23.8)3 (20.0)0.06Quality/effectiveness of the checklist16 (9.7)11 (25.6)5 (5.8)0 (0.0)0 (0.0)0.001Other16 (9.7)3 (7.0)11 (12.8)1 (4.8)1 (6.7)0.70Influence of an individual11 (6.7)2 (4.7)8 (9.3)0 (0.0)1 (6.7)0.56No issues11 (6.7)4 (9.3)2 (2.3)2 (9.5)3 (20.0)0.03OR logistics/equipment issues10 (6.1)1 (2.3)7 (8.1)2 (9.5)0 (0.0)0.46Staffing Issues7 (4.2)1 (2.3)5 (5.8)0 (0.0)1 (6.7)0.58Freedom to speak up6 (3.6)3 (7.0)1 (1.2)2 (9.5)0 (0.0)0.09∗ Chi-squares and Fisher's exact test were used to determine p-value Open table in a new tab ConclusionIn this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures. In this study, physicians were more likely to comment on the poor quality/ineffectiveness of surgical checklists. Non-physicians expressed significant concern regarding lack of physician buy-in and time constraints. Results raise concern regarding physician compliance. An institution's insight about perceptions of safety and differences between physicians and other OR staff may facilitate successful implementation of surgical safety checklists. Targeting specific concerns prior to and during implementation of surgical safety checklists may improve adoption and efficacy of these measures.