Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist

Abstract

Background The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low‐income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally. Methods This study had a longitudinal embedded mixed‐methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty‐six hospitals received 3‐day multidisciplinary training and 4‐month follow‐up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR‐derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups. Results At 12–18 months, 86·0 per cent of participants (86 of 100) reported checklist use compared with 31·1 per cent (169 of 543) before training and 88·8 per cent (158 of 178) at 4 months. There was high‐fidelity use (median WHOBARS score 5·0 of 7; use of basic safety processes ranged from 85·0 to 99·0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76·7, 81·1 and 82·2 per cent before, and at 4 and 12–18 months after training respectively; P < 0·001). Acceptability, adoption, appropriateness and feasibility scored 9·6–9·8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully. Conclusion This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

“…Common qualitative methods utilized across the studies included focus group discussions and key informant interviews. Mixed methods studies used review of financial records [15], routine facility, or surveillance indicators [13,17,22,28,43], health worker questionnaires or other quantitative study process indicators [10,20,23,28,29], or validated surveys to calculate measures such as organizational readiness and provider burnout [24] in conjunction with qualitative research. CFIR constructs can be scored quantitatively and compared across cases according to strength and valence [44].…”

The Factors Affecting Teachers’ Readiness In Developing Science Concept Assessment Through Inquiry-Based Learning Process In Elementary Schools

“…This study used a Likert Scale to measure and collect data by measuring and weighing the items of questions containing leveled choices (White et al, 2019). Data from respondents were collected using descriptive questionnaires which had levels.…”

Pediatric Cardiac Service Development Programs for Low- and Middle-Income Countries in Need of Improving or Initiating Local Services

“…As part of our daily practice, but most importantly, part of our education process, we have implemented a Time-Out routine in every country we operate regardless of local custom (61).…”