title: Attitudes and beliefs about the surgical safety checklist: Just another tick box?
abstract: BACKGROUND
  Following a landmark study showing decreased morbidity and mortality after implementation of the surgical safety checklist (SSC), it has been widely adopted into perioperative policy. We explored the impact of attitudes and beliefs surrounding the SSC on its uptake in Calgary.
  
  
  METHODS
  We used qualitative methodology to examine factors influencing SSC use. We performed semistructured interviews based on Rogers' theory of diffusion of innovation. Purposive and snowball sampling were used to identify surgeons, anesthesiologists and operating room nurses from hospitals in Calgary. Data collection and analysis were based on grounded theory. Two individuals jointly analyzed data and achieved consensus on emerging themes.
  
  
  RESULTS
  Generated themes included 1) the SSC has brought organization to previous informal perioperative checks, 2) the SSC is most helpful when it is simple, and 3) the 3 current components of the checklist are redundant. The briefing was considered the most important aspect and the debriefing the least important. Initially the SSC was difficult to implement owing to a shift in time management and perioperative culture; however, it has now assimilated into perioperative routine. Finally, though most participants agreed that the SSC might avoid some delays and complications, only a few believe there have been observable improvements to morbidity and mortality.
  
  
  CONCLUSIONS
  Although the SSC has been integrated into perioperative practice in Calgary, participants believe that previous informal checkpoints were able to circumvent most perioperative issues. Although the SSC may help with flow and equipment, participants believe it fails to show a subjective, clinically important improvement.
authors.affiliation: From the Department of General Surgery, University of Calgary, Calgary Alta. (Dharampal, Cameron, Dixon, Quan); and the Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta. (Ghali).
authors.forename: Navjit
authors.initials: N
authors.lastname: Dharampal
authors.affiliation: From the Department of General Surgery, University of Calgary, Calgary Alta. (Dharampal, Cameron, Dixon, Quan); and the Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta. (Ghali).
authors.forename: Christopher
authors.initials: C
authors.lastname: Cameron
authors.affiliation: From the Department of General Surgery, University of Calgary, Calgary Alta. (Dharampal, Cameron, Dixon, Quan); and the Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta. (Ghali).
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: From the Department of General Surgery, University of Calgary, Calgary Alta. (Dharampal, Cameron, Dixon, Quan); and the Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta. (Ghali).
authors.forename: William
authors.initials: W
authors.lastname: Ghali
authors.affiliation: From the Department of General Surgery, University of Calgary, Calgary Alta. (Dharampal, Cameron, Dixon, Quan); and the Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alta. (Ghali).
authors.forename: May Lynn
authors.initials: ML
authors.lastname: Quan
mesh_terms: D000416:Alberta; D057189:Checklist / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D019990:Perioperative Care / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000592:standards*