Mobilising a team for the WHO Surgical Safety Checklist: a qualitative video study Terhi Korkiakangas ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bmjqs-2015-004887). Correspondence to Dr Terhi Korkiakangas, UCL Institute of Education, University College London, London WC1N 3QS, UK; t.korkiakangas@ioe.ac.uk Received 28 September 2015 Revised 22 January 2016 Accepted 30 January 2016 To cite: Korkiakangas T. BMJ Qual Saf Published Online First: [ please include Day Month Year] doi:10.1136/ bmjqs-2015-004887 ABSTRACT Background One challenge identified in the Surgical Safety Checklist literature is the inconsistent participation of operating teams in the safety checks. Less is known about how teams move from preparatory activities into a huddle, and how communication underpins this gathering. The objective of this study is to examine the ways of mobilising teams and the level of participation in the safety checks. Methods Team participation in time-out and sign-out was examined from a video corpus of 20 elective surgical operations. Teams included surgeons, nurses and anaesthetists in a UK teaching hospital, scheduled to work in the operations observed. Qualitative video analysis of team participation was adapted from the study of social interaction. Results The key aspects of team mobilisation were the timing of the checklist, the distribution of personnel in the theatre and the instigation practices used. These were interlinked in bringing about the participation outcomes, the number of people huddling up for time-out and sign-out. Timing seemed appropriate when most personnel were present in the theatre suite; poor timing was marked by personnel dispersed through the theatre. Participation could be managed using the instigation practices, which included or excluded participation within teams. The factors hindering full-team participation at time-out and sign-out were the overlapping (eg, anaesthetic and nursing) responsibilities and the use of exclusive instigation practices. Conclusions The implementation of the Surgical Safety Checklist represents a global concern in patient safety research. Yet how teams huddle for the checks has to be acknowledged as an issue in its own right. Appropriate mobilisation practices can help bringing fuller teams together, which has direct relevance to team training. INTRODUCTION The Surgical Safety Checklist has become a mandatory safety measure in the UK hospitals since the WHO’s Safe Surgery Saves Lives campaign in 2008. 1 It was developed to minimise avoidable errors that pose a risk to patients, including the failure to check the administration of prophylactic antibiotics, undertaking an incorrect procedure, operating on a wrong body part or a wrong patient. 23 The checklist aims to improve team dia- logue during three stages: ‘sign-in’ (before induction of anaesthesia), ‘time-out’ (before first incision) and ‘sign-out’ (before patient leaves the operating room). These stages require that person- nel take short briefings and confirm crit- ical details about the patient and the procedure using the 19-point checklist. While sign-in requires the presence of anaesthetic and, ideally, the nursing per- sonnel, time-out and sign-out require the presence of the full operating team. The checklist implementation at time-out and sign-out can only take a few minutes and thus represents a seemingly simple safety intervention. In the WHO implementation manual, 4 the timing of time-out has been defined as the moment ‘immediately prior to the skin incision’ (p. 7). This is when teams ought to pause to confirm critical details about the patient and the procedure out loud and to intro- duce themselves by name (unless the same team operates partway through the day). Sign-out has been defined as the phase at the end of an operation (or as the manual 4 puts it, ‘before the surgeon has left the room’, p. 18). This involves a team review- ing critical issues related to the operation completed, instrument and swab counts and the patient’s recovery. However, in order to improve patient safety, the check- list implementation requires more than a tick in the box: cooperation between sur- geons, anaesthetists and nurses, which can be difficult to reach. In practice, the checklist use has been shown to be problematic and teams do ORIGINAL RESEARCH Korkiakangas T. BMJ Qual Saf 2016;0:1–12. doi:10.1136/bmjqs-2015-004887 1 BMJ Quality & Safety Online First, published on 29 February 2016 as 10.1136/bmjqs-2015-004887 Copyright Article author (or their employer) 2016. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on June 8, 2016 - Published by http://qualitysafety.bmj.com/ Downloaded from