RT Journal Article SR Electronic T1 Effectiveness of facilitated introduction of a standard operating procedure into routine processes in the operating theatre: a controlled interrupted time series JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 120 OP 127 DO 10.1136/bmjqs-2014-003158 VO 24 IS 2 A1 Lauren Morgan A1 Steve New A1 Eleanor Robertson A1 Gary Collins A1 Oliver Rivero-Arias A1 Ken Catchpole A1 Sharon P Pickering A1 Mohammed Hadi A1 Damian Griffin A1 Peter McCulloch YR 2015 UL http://qualitysafety.bmj.com/content/24/2/120.abstract AB Background Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Methods In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. Process measures were evaluated by direct observation, using Oxford Non-Technical Skills II for non-technical skills and the ‘glitch count’ for technical performance. All staff in two orthopaedic operating theatres were trained in the principles of SOPs and then assisted to develop standardised procedures. Staff in a control operating theatre underwent the same observations but received no training. The change in difference between active and control groups was compared before and after the intervention using repeated measures analysis of variance. Results We observed 50 operations before and 55 after the intervention and analysed clinical data on 1022 and 861 operations, respectively. The staff chose to structure their efforts around revising the ‘whiteboard’ which documented and prompted tasks, rather than directly addressing specific task problems. Although staff preferred and sustained the new system, we found no significant differences in process or outcome measures before/after intervention in the active versus the control group. There was a secular trend towards worse outcomes in the postintervention period, seen in both active and control theatres. Conclusions SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change.