Table 1

Themes describing user-related changes required conducting the checklist as intended with exemplary citations from the study findings

Main themeSubthemeExemplary citations from the study findings
Staffs’ perception of the checklist and patient safetyConcerns about legal implicationsNurses were therefore concerned about the legal implications of signing the checklist as they might be held accountable for errors.68
Concerns about patient perceptionFor example, some stated that patients often did not understand why they had to confirm their ID/procedure, etc., so many times during their surgical pathway, and others felt that specific questions around blood loss and difficult airway (part of the sign-in checks) would anxiety provoking for certain patients (this was a particular concern if the patient was undergoing a local anaesthetic procedure and therefore witnessed all of the checks).76
Concerns about time consumption and efficiency…respondents had significant concern about its perceived effect on OR efficiency.70
Perceived importanceConfirming the team members by name and role was the most missed check. The explanation given for this was that a lack of staff turnover and degree of familiarity with each other made this check appear less important.73
Scepticism regarding the evidence baseScepticism regarding the evidence base: The evidence base behind the checklist is weak and/or not applicable to the current context.76
Workflow adjustmentsIndividual workflow adjustmentsTwo participants expressed concern about the interruption in workflow that was sometimes required to complete the checklist discussion.61
Aligning the workflow of team membersThese asynchronous workflows impacted on a healthcare professional's ability to halt their work and collaboratively meet to communicate at a time-out procedure: Time out was about to commence and the nurse initiating it asked the anaesthetist “Are you joining us?” The anaesthetist replies, “No, we have things to do”. [Obs_circnurs_125]25