Factors that drive team participation in surgical safety checks: a prospective study

BACKGROUND: Team-based group communications using checklists are widely advocated to achieve shared understandings and improve patient safety. Despite the positive effect checklists have on collaborations and reduced postoperative complications, their use has not been straightforward. Previous research has described contextual factors that impact on the implementation of checklists, however there is limited understanding of the issues that impede team participation in checklist use in surgery. The aim of this prospective study was to identify and describe factors that drive team participation in safety checks in surgery. METHODS: We observed ten surgical teams and conducted 33 semi-structured interviews with 70 participants from nursing, surgery and anaesthetics, and the community. Constant comparative methods were used to analyse textual data derived from field notes and interviews. Observational and interview data were collected during 2014–15. RESULTS: Analysis of the textual data generated from the field notes and interviews revealed the extent to which members of the surgical team participated in using the surgical safety checklist during each phase of patient care. These three categories included: ‘using the checklist’; ‘working independently’; and, ‘communicating checks with others’. The phases in the checking process most vulnerable to information loss or omission were sign in and sign out. CONCLUSIONS: Team participation in safety checks depends on a convergence of intertwined factors; namely, team attributes, communication strategies and checking processes. A whole-of-team approach to participation in surgical safety checks is far more complex when considering the factors that drive participation. Strategies to increase participation in safety checks need to target professional communication practices and work processes such as workflow which curtail team members’ ability to participate.