Surgery

Statement of the Problem: WHO Surgical Safety Checklist has become mandatory to use in most countries (WHO, 2009). Initial studies reported large reductions in both mortality and morbidity (Haynes et al 2009), though a large scale Canadian study raised concern about quality of the implementation and actual use of the checklist (Urbach et al 2014, Leap 2014). In recent studies, a stepped wedge RCT in Norway reported significant reduction of morbidity (43%) and length of stay (19 hours) (Haugen et al 2015), and further mortality was reduced in U.S. South Carolina Hospitals by 22% (Haynes et al 2017). In an invited commentary in JAMA Surgery Berry et al (2016) stated that the checklist will not work if you do not use it. The purpose of this study is to describe the experience on how to obtain a high compliance and sustainable use of the checklist.

Methodology & Theoretical Orientation: A review of research results and experiences on implementation of the WHO SSC in a stepped wedge cluster RCT and qualitative studies in Norwegian hospitals is combined with compliance rates from January 2014 to April 2017.

Findings: The results from our stepped wedge cluster RCT boosted attention to perform the SSC in our hospitals. Health trust and management focus on compliance combined with multi-disciplinary tailoring of the SSC, contributed over time to sustainable and increased actual use of the SSC (Fig 1).

Conclusion & Significance: Effectiveness and sustainable use of the SSC is depending on multidisciplinary surgical teams to play an active part in tailoring the checklist, and of managers being accountable for the compliance rates.