title: Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention.
abstract: OBJECTIVE
  To assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention.
  
  
  METHODS
  Pre- and post intervention survey.
  
  
  METHODS
  Eight hospitals participating in a trial of a WHO surgical safety checklist.
  
  
  METHODS
  Clinicians actively working in the designated study operating rooms at the eight hospitals.
  
  
  METHODS
  Modified operating-room version Safety Attitudes Questionnaire (SAQ).
  
  
  METHODS
  Change in mean safety attitude score and correlation between change in safety attitude score and change in postoperative outcomes, plus clinician opinion of checklist efficacy and usability.
  
  
  RESULTS
  Clinicians in the preintervention phase (n=281) had a mean SAQ score of 3.91 (on a scale of 1 to 5, with 5 representing better safety attitude), while the postintervention group (n=257) had a mean of 4.01 (p=0.0127). The degree of improvement in mean SAQ score at each site correlated with a reduction in postoperative complication rate (r=0.7143, p=0.0381). The checklist was considered easy to use by 80.2% of respondents, while 19.8% felt that it took a long time to complete, and 78.6% felt that the programme prevented errors. Overall, 93.4% would want the checklist used if they were undergoing operation.
  
  
  CONCLUSIONS
  Improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist. Clinicians held the checklist in high regard and the overwhelming majority would want it used if they were undergoing surgery themselves.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Kresge 440, Boston, MA 02115, USA.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Abdel-Hadi S
authors.initials: AH
authors.lastname: Breizat
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Gerald
authors.initials: G
authors.lastname: Dziekan
authors.forename: Teodoro
authors.initials: T
authors.lastname: Herbosa
authors.forename: Pascience L
authors.initials: PL
authors.lastname: Kibatala
authors.forename: Marie Carmela M
authors.initials: MC
authors.lastname: Lapitan
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
authors.forename: Richard K
authors.initials: RK
authors.lastname: Reznick
authors.forename: Bryce
authors.initials: B
authors.lastname: Taylor
authors.forename: Amit
authors.initials: A
authors.lastname: Vats
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D057189:Checklist; D006284:Health Plan Implementation; D006801:Humans; D009873:Operating Rooms; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care; D017751:Safety Management; D013503:Surgery Department, Hospital / Q000592:standards*