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. 2012 Mar;21(3):191-7.
doi: 10.1136/bmjqs-2011-000094. Epub 2011 Nov 7.

Barriers to staff adoption of a surgical safety checklist

Aude Fourcade  1 , Jean-Louis Blache, Catherine Grenier, Jean-Louis Bourgain, Etienne Minvielle
Affiliations

Barriers to staff adoption of a surgical safety checklist

Aude Fourcade et al. BMJ Qual Saf. 2012 Mar.

Abstract

Objective: Implementation of a surgical checklist depends on many organisational factors and on socio-cultural patterns. The objective of this study was to identify barriers to effective implementation of a surgical checklist and to develop a best use strategy.

Setting: 18 cancer centres in France.

Design: The authors first assessed use compliance and completeness rates of the surgical checklist on a random sample of 80 surgical procedures performed under general or loco-regional anaesthesia in each of the 18 centres. They then developed a typology of the organisational and cultural barriers to effective checklist implementation and defined each barrier's contents using data from collective and semi-structured individual interviews of key staff, the results of an email questionnaire sent to the 18 centres, and direct observations over 20 h in two centres.

Results: The study consisted of 1440 surgical procedures, 1299 checklists, and 28 578 items. The mean compliance rate was 90.2% (0, 100). The mean completion rate was 61% (0, 84). 11 barriers to effective checklist implementation were identified. Their incidence varied widely across centres. The main barriers were duplication of items within existing checklists (16/18 centres), poor communication between surgeon and anaesthetist (10/18), time spent completing the checklist for no perceived benefit, and lack of understanding and timing of item checks (9/18), ambiguity (8/18), unaccounted risks (7/18) and a time-honoured hierarchy (6/18).

Conclusions: Several of the barriers to the successful implementation of the surgical checklist depended on organisational and cultural factors within each centre. The authors propose a strategy for change for checklist design, use and assessment, which could be used to construct a feedback loop for local team organisation and national initiatives.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Surgical safety checklist published by the French National Authority for Health (HAS) (January 2010 version*). An updated version was published in January 2011.
Figure 2
Figure 2
Rates of compliance of use (A) and completeness (B) recorded for the surgical checklist.
See this image and copyright information in PMC

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