Managerial Challenges in the Clinical Use of Checklists: Proven Benefits, Yet Untapped Potential?

Abstract

Purpose: Research shows that surgical safety checklists can reduce adverse events in hospitals, but their real-world effectiveness varies due to inconsistent implementation. This study investigates managerial barriers to effective checklist use across surgical subspecialties, focusing on factors like organisational structure, workplace culture, and staff attitudes. Patient safety is a shared responsibility, yet differences in priorities and communication between system-level and frontline management can hinder safety efforts. Theories such as high reliability and complex adaptive systems highlight the importance of feedback and alignment between strategic goals and operational realities. Methods: Using semi-structured interviews at two Norwegian university hospitals, the study explores perceptions of checklist use among section and clinic managers. Nine participants, representing both nursing and medical backgrounds, provided insights into the challenges of integrating checklists into daily practice. The data were analysed to identify barriers and their underlying causes, aiming to inform strategies for improving checklist implementation and patient safety outcomes. Results: This evaluation of surgical safety checklist practices reveals a significant gap between policy and practice. While the checklist is widely accepted and integrated into routine surgical workflows, its actual use is rarely monitored or discussed across managerial levels. Senior managers often assume compliance without verification, and checklist non-compliance is seldom reported through formal deviation systems. Communication about checklist use is fragmented, and key elements—such as the team presentation round—are frequently overlooked. The checklist is treated more as a static tool than as part of a dynamic safety system. Systemic barriers, including competing priorities and limited feedback mechanisms, hinder its effective use. Conclusion: To enhance patient safety, hospitals must adopt a more adaptive and reflective safety culture, integrating checklist use into broader governance frameworks and establishing mechanisms for monitoring, feedback, and continuous learning.