title: Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety.
abstract: Previous research suggests that surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room.
  
  
  
  As part of the Safe Surgery 2015 initiative to implement SSCs in South Carolina hospitals, we administered a validated survey designed to measure perception of multiple dimensions of perioperative safety among clinical operating room personnel before and after implementation of an SSC.
  
  
  
  Thirteen hospitals administered baseline and follow-up surveys, separated by 1 to 2 years. Response rates were 48.4% at baseline (929 of 1,921) and 42.7% (815 of 1,909) at follow-up. Results suggest improvement in all of the 5 dimensions of teamwork (relative percent improvement ranged from +2.9% for coordination to +11.9% for communication). These were significant after adjusting for respondent characteristics, hospital fixed-effects, multiple comparisons, and clustering robust standard errors by hospital (all p < 0.05). More than half of respondents (54.1%) said their surgical teams always used checklists effectively; 73.6% said checklists had averted problems or complications.
  
  
  
  A large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: George
authors.initials: G
authors.lastname: Molina
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA.
authors.forename: Lizabeth
authors.initials: L
authors.lastname: Edmondson
authors.affiliation: South Carolina Hospital Association, Columbia, SC.
authors.forename: Lorri
authors.initials: L
authors.lastname: Gibbons
authors.affiliation: Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA.
authors.forename: Lyen C
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA.
authors.forename: Mathew V
authors.initials: MV
authors.lastname: Kiang
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA.
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA.
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.affiliation: Ariadne Labs at Brigham and Women's Hospital and the Harvard TH Chan School of Public Health, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA; Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA. Electronic address: ssinger@hsph.harvard.edu.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
mesh_terms: D001291:Attitude of Health Personnel; D057189:Checklist / Q000379:methods / Q000592:standards*; D003142:Communication; D006282:Health Personnel / Q000523:psychology / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D010465:Perception; D059035:Perioperative Period; D058996:Quality Improvement / Q000592:standards*; D013022:South Carolina