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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/829
Title: Improving the quality of administration of the Surgical Safety Checklist: a mixed methods study in New Zealand hospitals
Authors: Weller Jennifer M
Jowsey Tanisha
Skilton Carmen
Gargiulo Derryn A
Medvedev Oleg N
Civil Ian
Hannam Jacqueline A
Mitchell Simon J
Torrie Jane
Merry Alan F
ANZCA/FPM Author: Merry, AF
Mitchell, SJ
Torrie, J
Weller, JM
Keywords: checklists
evaluation methodology
human factors
patient safety
quality improvement
surgery
Issue Date: 2018
Citation: 2018 Dec 16;8(12):e022882.
Abstract: Abstract While the WHO Surgical Safety Checklist (the Checklist) can improve patient outcomes, variable administration can erode benefits. We sought to understand and improve how operating room (OR) staff use the Checklist. Our specific aims were to: determine if OR staff can discriminate between good and poor quality of Checklist administration using a validated audit tool (WHOBARS); to determine reliability and accuracy of WHOBARS self-ratings; determine the influence of demographic variables on ratings and explore OR staff attitudes to Checklist administration. DESIGN: Mixed methods study using WHOBARS ratings of surgical cases by OR staff and two independent observers, thematic analysis of staff interviews. PARTICIPANTS: OR staff in three New Zealand hospitals. OUTCOME MEASURES: Reliability of WHOBARS for self-audit; staff attitudes to Checklist administration. RESULTS: Analysis of scores (243 participants, 2 observers, 59 cases) supported tool reliability, with 87% of WHOBARS score variance attributable to differences in Checklist administration between cases. Self-ratings were significantly higher than observer ratings, with some differences between professional groups but error variance from all raters was less than 10%. Key interview themes (33 interviewees) were: Team culture and embedding the Checklist, Information transfer and obstacles, Raising concerns and 'A tick-box exercise'. Interviewees felt the Checklist could promote teamwork and a safety culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone. CONCLUSIONS: The WHOBARS tool could be useful for self-audit and quality improvement as OR staff can reliably discriminate between good and poor Checklist administration. OR staff self-ratings were lenient compared with external observers suggesting the value of external audit for benchmarking. Small differences between ratings from professional groups underpin the value of including all members of the team in scoring. We identified factors explaining staff perceptions of the Checklist that should inform quality improvement interventions.
URI: http://hdl.handle.net/11055/829
DOI: http://dx.doi.org/10.1136/bmjopen-2018-022882
Journal Title: BMJ open
Type: Journal Article
Study/Trial: Observational study
Appears in Collections:Scholarly and Clinical

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