title: Impact of workflow on the use of the Surgical Safety Checklist: a qualitative study.
abstract: BACKGROUND
  Regardless of the benefits associated of the Surgical Safety Checklist, adherence across its three phases remains inconsistent. The aim of this study was to systematically identify issues around workflow that impact on surgical teams' ability to use the Surgical Safety Checklist in a large tertiary facility in Queensland, Australia.
  
  
  METHODS
  Observational audit of 10 surgical teams and 33 semi-structured interviews with 70 participants from nursing, medicine and the community were conducted. Data were collected during 2014-2015. Inductive and deductive approaches were used to analyse field observations and interview transcripts.
  
  
  RESULTS
  The domain, impact of workflow on checklist utilization, was identified. Within this domain, seven categories illustrated the causal conditions which determined the ways in which workflow influenced checklist use. These categories included: 'busy doing the task'; 'clashing task priorities'; 'being pressured, running out of time'; 'adapting processes to work patterns'; 'doubling up on work'; 'a domino effect, leading to delays' and 'reality of the workflow'.
  
  
  CONCLUSIONS
  One of the greatest systemic challenges to checklist use in surgery is workflow. Process changes in the way that surgical safety checklists are used need to incorporate the temporal demands of the workflow. Any changes made must ensure the process is reliable, is easily embedded into existing work routines and is not disruptive.
authors.affiliation: NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia. b.gillespie@griffith.edu.au.
authors.forename: Brigid M
authors.initials: BM
authors.lastname: Gillespie
authors.affiliation: NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia.|Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia.|School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Marshall
authors.affiliation: Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Therese
authors.initials: T
authors.lastname: Gardiner
authors.affiliation: Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lavin
authors.affiliation: Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Teresa K
authors.initials: TK
authors.lastname: Withers
mesh_terms: D057189:Checklist / Q000379:methods*; D054869:Clinical Audit; D017558:Elective Surgical Procedures / Q000592:standards*; D006801:Humans; D010348:Patient Care Team / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D058996:Quality Improvement; D011793:Queensland; D012189:Retrospective Studies; D017751:Safety Management / Q000592:standards*; D057188:Workflow
keywords: Surgical Safety Checklist; process map; team communication; work processes