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.
Highlights
The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery
As part of the implementation process, development of the program was co-constructed with end-users who included operating room nurses working in circulating/instrument and anaesthetic roles and physicians specialising in anaesthetics and surgery
While Pass The Baton (PTB) was implemented department-wide, 59.6% (n = 57) indicated they thought that PTB was currently a normal part of their work (M = 6.5, standard deviations (SD) = 2.5) and 76.8% (n = 56) indicated they believed PTB will become a normal part of their work (M = 7.8, SD = 2.1)
Summary
The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Despite the encouraging results of many published studies [3,4,5] including several meta-analyses that suggest use of the SSC leads to reductions in patient morbidity and mortality [6, 7], compliance and sustained use remains a challenge [4, 8]. This challenge arises from differing institutional contexts with inconsistent implementation strategies. Using theory-led research designs to explain the implementation and integration of multifaceted interventions may inform the development of strategies to embed their use in practice
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