The checklist | Checklist content | The binary (yes/no) response system was ambiguous and confusing.68 |
| Execution process did not merge with existing processes | … duplication with existing processes that already covered several of the items in the surgical checklist.68 |
| Psychological ownership | … they [surgeons] did not necessarily agree with it, albeit this protocol was endorsed by the College of Surgeons.62 |
| | staff should have been involved in adapting and implementing the SSC as a means of fostering ownership.74 |
The implementation process | Education and training | Many participants said that they did not receive information or training on how to use the SSC…. 74 |
| Unclear guidelines | Many participants said that staff were uncertain about how to use the SSC and who was responsible for leading it.74 |
| Surgeons commitment | Physician's support and motivation were crucial for implementing the checklist.63 |
The local context | Executive leadership | … lack of clarity and agreement with protocol specifics, and inadequate executive leadership primarily resulted in reduced ownership and acceptance of the protocol by physicians.68 |
| | Hospital leadership was not seen as involved in either promoting or actively implementing the SSC.74 |
| Organisational culture | The same proportion of staff held the perception that the culture within their hospital was that of a general resistance to the introduction of change, whatever form it takes, particularly from more senior members of staff.76 |
| Communication and teamwork | We often talk about being one team, but it is in itself three teams. The surgeons don't see themselves as part of the team; they see the others forming the team, but they invite in so to speak.62 |