Barriers and facilitators for implementing WHO's Surgical Safety Checklist in a publicly funded hospital: a qualitative study from a tertiary-level public hospital in Croatia.

Abstract

To explore the barriers and facilitators to implementing the WHO's Surgical Safety Checklist (SSC) at a tertiary-level hospital in Croatia, a country with a publicly funded universal healthcare system. Focus group-based study which used Graneheim and Lundman's qualitative content analysis approach. We used purposive sampling to gather participants who were representative of the usual surgical team: nurses, residents, anaesthesiologists and surgeons. Aside from this requirement, we set no specific inclusion or exclusion criteria. We conducted 6 focus groups (2 with nurses, 2 with residents, 1 with anaesthesiologists and 1 with surgeons) with 29 participants. The nurses were all female, the residents and surgeons were all male, and anaesthesiologists were mostly male (60%). Most participants had at least a bachelor's degree (93%). The focus groups were held in person at the hospital's Department of Surgery in Croatia and were conducted in the local language, based on a predeveloped topic guide. Our analysis revealed two distinct themes that were fundamentally independent of each other. The first concerned within-team hierarchies and relationships that prevented the SSC from being used as intended, while the second was related to a diverse set of resource and logistical constraints that had existed before the implementation of the SSC. Understanding the barriers faced by healthcare providers is crucial in designing training programmes that could help integrate the SSC into routine surgical practice. Our findings highlight the importance of actively including members of the surgical team in the implementation of the SSC and implementing interventions for improving within-team communication.