Refining Successful Implementation Strategies for the Surgical Safety Checklist in High-Income Contexts: Results of an International Mixed Methods Study

Authors

Meagan E. Elam, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, and Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA 02215Follow
Christopher J. Louis, Boston University School of Public Health, 715 Albany St, Boston, MA 02118Follow
Jonathan Woodson, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, and Boston University School of Medicine, 72 E Concord St, Boston, MA 02118Follow
Nathan Turley, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, CanadaFollow
Denisa Urban, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, CanadaFollow
Mary E. Brindle, Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA 02215, and Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, CanadaFollow
Jacey A. Greece, Boston University School of Public Health, 715 Albany St, Boston, MA 02118Follow

Abstract

The WHO Surgical Safety Checklist (SSC) continues to show inconsistent success in reducing surgical complications in high-income settings. Previous implementation research identified potential barriers and facilitators to success, but it primarily consists of qualitative studies with small sample sizes in limited geographic areas. We conducted a multi-country mixed-methods study of barriers and facilitators to SSC implementation to better inform policies and practices for improving SSC buy-in and use to maximize its impact. This convergent parallel mixed-methods study utilized survey and interview data from surgical team members practicing in five countries. Survey data were analyzed using χ² analysis or Fisher’s exact test for categorical variables and McNemar’s test to analyze differences between related groups for dichotomous variables. Interview data underwent inductive coding followed by thematic analysis for predominant themes common across the study countries. The study resulted in 2,032 survey responses and 51 interviews. Facilitators to success included having influential multi-disciplinary champions from surgery, anesthesiology, and nursing; using a distributed leadership process to promote ownership across all surgical team members; and providing education on the “why” of the checklist. Practitioners found patient safety metrics (e.g., wrong side surgery) more relevant than clinical outcome measures (e.g., surgical mortality) to assess SSC success. Finally, auditing for process engagement was felt to promote more meaningful use than auditing for checklist completion. Our international examination of barriers and facilitators to successful SSC implementation has identified more specific guidance for high-income settings that integrate people, data, and processes.

Recommended Citation

Elam ME, Louis CJ, Woodson J, Turley N, Urban D, Brindle ME, Greece JA. Refining Successful Implementation Strategies for the Surgical Safety Checklist in High-Income Contexts: Results of an International Mixed Methods Study. Patient Experience Journal. 2024; 11(1):89-98. doi: 10.35680/2372-0247.1873.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.