Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures

Abstract

The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what "ought" to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients' involvement in their operative experience.

Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center

“…Although surgeons are commonly described as being the leaders in the OR, another study revealed similar observations i.e. the staff surgeon was often not in the OR during the briefing and the process was delegated to another OR team member [10]. Furthermore, the most common barrier to checklist implementation was active resistance or passive noncompliance from individuals in the OR team, most frequently from senior surgeons and/or anesthesiologists [11].…”

Processes and tools to improve teamwork and communication in surgical settings: a narrative review

“…59 Recent work has highlighted that the adoption of the SSC is informed by factors related to the surgical team members' perceived importance of the tool, the profession leads the SSC use (eg, surgery, anaesthesia or nursing), and differences in workflow. 60 Similar to this review, CPSI reported that most tools or processes seek to structure or standardise communication, often in accordance with processes from highreliability industries, such as aviation, with a need to shift patient safety culture. 61 In our review, patient safety culture was often referred to as a barrier to process or tool implementation.…”

How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties in Norway

“…(42) How team members perceive SSC sense making in practice has further been related to the relevance of specific SSC items, and possibilities of tailoring SSC content to local context. (25,27,43,44) Anaesthesiologists have previously been identified as being the least positively disposed towards SSC completions, when compared with surgeons and nurses. (45) We found that nurse anaesthetists and anaesthesiologists in particular reported that their existing safety protocols and procedures such as the pre-anaesthetic patient risk assessment were sufficient.…”