Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures

ABSTRACT

The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what “ought” to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients’ involvement in their operative experience.

KEYWORDS:

• Ethnography
• interprofessional
• patient safety
• surgical safety checklist
• teamwork

Supplemental data

Supplemental data for this article can be accessed here .

Acknowledgments

The authors would like to thank Michelle Olding (BC Centre for Excellence in HIV/AIDS) for providing project coordination during data collection, Sarah McMillan (University Health Network) for her helpful comments on this manuscript, and Dr. Oleg Safir for his support of the project.

Declaration of interest

The authors declare no conflicts of interest. The authors alone are responsible for the writing and content of this article.

Additional information

Funding

This work was supported by funding from the Office of the Vice President, Research & Innovation, Ryerson University and Faculty of Community Services, Ryerson University.