Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklist

Abstract

Background: The World Health Organization Surgical Safety Checklist (WHO Checklist) fosters communication and teamwork among the perioperative team; however, perceptions influence its acceptance and use. This study explores the perceptions of the perioperative team regarding the WHO Checklist in operating theatres at the University of the Witwatersrand (Wits) affiliated hospitals. Methods: A qualitative, contextual, and exploratory research design was employed. Purposive sampling was used to invite theatre nurses, anaesthetists, and surgeons to participate. Focus group interviews were held for each group, which were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results: Ten nurses, six anaesthetists, and four surgeons participated in the focus group interviews. Four themes relating to patient safety were identified: the prevalence of power struggles in theatre, a breakdown in communication, a culture of silence, and inadequate and siloed training. The metaphor of a daily flight plagued by turbulence describes the perceptions of the interviewed perioperative teams, which may result in serious adverse events. Conclusion: In a complex system, such as a hospital theatre environment, introducing a simple tool, such as the WHO Checklist, is perceived to have a limited impact on patient safety if the underlying supportive network is not intact. This study demonstrates the importance of interpersonal relationships, changing teams, lack of integration of teams, processes, and training on the use of the WHO Checklist as a safety tool in a South African hospital setting. A prevailing culture of safety is a prerequisite for the successful implementation and use of the WHO Checklist.