Safe Surgery Checklist Implementation: Associations of Management Practice and Safety Culture Change

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Safety culture, shared values with regard to safety management, is a key driver of high-quality health care delivery. The Safe Surgery Checklist (SSC) is an innovative tool for improving surgical care safety, but evidence about SSC effectiveness is mixed. While a structured implementation and management commitment are considered important, limited evidence exists about what managerial practices support safety culture, and how SSC implementation can impact the organization’s managerial practices and safety culture. We examined the relationship between management practices and perceived safety culture and the way checklist implementation induces change in both. Using a pre-posttest design and survey methods, we evaluated the implementation of SSC in a national sample of 42 general acute care hospitals affiliated with a leading hospital system. We measured perceived management practices among management (n=99) using the World Management Survey. We administered the Safe Surgical Practice Survey to clinical operating room personnel to measure perception of pre-operative safety and safety culture (N= 2380 in 2016 and N= 1433 in 2017). Data was collected in two consecutive years. Linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following SSC implementation.