title: Effective surgical safety checklist implementation.
abstract: BACKGROUND
  Research suggests that surgical safety checklists can reduce mortality and other postoperative complications. The real world impact of surgical safety checklists on patient outcomes, however, depends on the effectiveness of hospitals' implementation processes.
  
  
  METHODS
  We studied implementation processes in 5 Washington State hospitals by conducting semistructured interviews with implementation leaders and surgeons from September to December 2009. Interviews were transcribed, analyzed, and compared with findings from previous implementation research to identify factors that distinguish effective implementation.
  
  
  RESULTS
  Qualitative analysis suggested that effectiveness hinges on the ability of implementation leaders to persuasively explain why and adaptively show how to use the checklist. Coordinated efforts to explain why the checklist is being implemented and extensive education regarding its use resulted in buy-in among surgical staff and thorough checklist use. When implementation leaders did not explain why or show how the checklist should be used, staff neither understood the rationale behind implementation nor were they adequately prepared to use the checklist, leading to frustration, disinterest, and eventual abandonment despite a hospital-wide mandate.
  
  
  CONCLUSIONS
  The impact of surgical safety checklists on patient outcomes is likely to vary with the effectiveness of each hospital's implementation process. Further research is needed to confirm these findings and reveal additional factors supportive of checklist implementation.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. cdante@uw.edu
authors.forename: Dante M
authors.initials: DM
authors.lastname: Conley
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.forename: Lizabeth
authors.initials: L
authors.lastname: Edmondson
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D057189:Checklist; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D007857:Leadership; D010348:Patient Care Team; D010565:Persuasive Communication; D011183:Postoperative Complications / Q000517:prevention & control*; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D017751:Safety Management; D013514:Surgical Procedures, Operative / Q000592:standards*; D014861:Washington