Objectives To assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention.
Design Pre- and post intervention survey.
Setting Eight hospitals participating in a trial of a WHO surgical safety checklist.
Participants Clinicians actively working in the designated study operating rooms at the eight hospitals.
Survey instrument Modified operating-room version Safety Attitudes Questionnaire (SAQ).
Main outcome measures Change in mean safety attitude score and correlation between change in safety attitude score and change in postoperative outcomes, plus clinician opinion of checklist efficacy and usability.
Results Clinicians in the preintervention phase (n=281) had a mean SAQ score of 3.91 (on a scale of 1 to 5, with 5 representing better safety attitude), while the postintervention group (n=257) had a mean of 4.01 (p=0.0127). The degree of improvement in mean SAQ score at each site correlated with a reduction in postoperative complication rate (r=0.7143, p=0.0381). The checklist was considered easy to use by 80.2% of respondents, while 19.8% felt that it took a long time to complete, and 78.6% felt that the programme prevented errors. Overall, 93.4% would want the checklist used if they were undergoing operation.
Conclusions Improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist. Clinicians held the checklist in high regard and the overwhelming majority would want it used if they were undergoing surgery themselves.
- healthcare quality improvement
- patient safety
- safety culture
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Safe Surgery Saves Lives Study Group: Amman: AS Breizat, AF Awamleh, OG Sadieh; Auckland: AF Merry, SJ Mitchell, V Cochrane, A-M Wilkinson, J Windsor, N Robertson, N Smith, W Guthrie, V Beavis; Ifakara: P Kibatala, B Jullu, R Mayoka, M Kasuga, W Sawaki, N Pak; London: A Darzi, K Moorthy, A Vats, R Davies, K Nagpal, M Sacks; Manila: G Herbosa, T Herbosa, MCM Lapitan, C Meghrajani; New Delhi: S Joseph, A Kumar, H Singh Chauhan; Seattle: EP Dellinger, K Gerber; Toronto RK Reznick, B Taylor, A Slater; Boston: WR Berry, AA Gawande, AB Haynes, SR Lipsitz, TG Weiser; Geneva: L Donaldson, G Dziekan, P Philip; Baltimore: M Makary; Ankara: I Sayek, Sydney B Barraclough.
Funding This study was funded by the WHO. The WHO had no role in study design, analysis or interpretation of data, or on the decision to publish.
Competing interests None.
Ethics approval The study was approved by the Human Subjects Committee of the Harvard School of Public Health, as well as by the ethics approval body at each of the participating hospitals.
Provenance and peer review Not commissioned; externally peer reviewed.
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