A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries
A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries
复制标题
DOI：
10.1136/bmjopen-2013-003039
复制
发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Dixon-Woods, Mary
中科院分区：
文献类型：
--
作者：
Aveling, Emma-Louise;McCulloch, Peter;Dixon-Woods, Mary
目的：有人大胆宣称，世卫组织手术清单能够降低手术发病率和死亡率，并提高患者安全性，无论在何种情况下。低收入国家所面临的挑战与高收入国家所面临的挑战在多大程度上相同或不同，人们对此知之甚少。我们的目的是确定和比较清单的实施和遵守在英国和Africa.Design的影响：民族志研究，包括观察，访谈和收集的文件。数据的专题分析。设置：在一所非洲大学医院和两所英国大学医院的手术室。参与者：112小时的观察进行。与39剧院和行政人员进行了采访。结果：许多工作人员看到的价值清单在英国和非洲的医院。在所有情况下都存在一些不满情绪，这与清单背后的理念与当地文化、社会和经济背景的现实之间的冲突有关。在英国的环境中，涉及使用、完整性和可靠性的合规性相当高，尽管并不完美。在这些医院中，合规性得到了既定结构和系统的支持，并且没有因主要资源限制而受到显着破坏;低收入环境并非如此。等级关系是所有环境中执行的主要障碍，但在低收入环境中更为明显。在一个缺乏问责制和透明度的专业环境中采用清单，可能会使工作人员感到在法律、专业和个人方面受到损害，并鼓励他们对实际所做的事情作出误导性的记录。无论设置如何，手术清单的实施都可能得到优化，当被用作多方面文化和组织计划的工具时，以加强患者安全。不能假定采用检查表会自动改善沟通和临床流程。
Objective: Bold claims have been made for the ability of the WHO surgical checklist to reduce surgical morbidity and mortality and improve patient safety regardless of the setting. Little is known about how far the challenges faced by low-income countries are the same as those in high-income countries or different. We aimed to identify and compare the influences on checklist implementation and compliance in the UK and Africa.Design: Ethnographic study involving observations, interviews and collection of documents. Thematic analysis of the data.Setting: Operating theatres in one African university hospital and two UK university hospitals.Participants: 112 h of observations were undertaken. Interviews with 39 theatre and administrative staff were conducted.Results: Many staff saw value in the checklist in the UK and African hospitals. Some resentment was present in all settings, linked to conflicts between the philosophy behind the checklist and the realities of local cultural, social and economic contexts. Compliance-involving use, completeness and fidelity-was considerably higher, though not perfect, in the UK settings. In these hospitals, compliance was supported by established structures and systems, and was not significantly undermined by major resource constraints; the same was not true of the low-income context. Hierarchical relationships were a major barrier to implementation in all settings, but were more marked in the low-income setting. Introducing a checklist in a professional environment characterised by a lack of accountability and transparency could make the staff feel jeopardised legally, professionally, and personally, and it encouraged them to make misleading records of what had actually been done.Conclusions: Surgical checklist implementation is likely to be optimised, regardless of the setting, when used as a tool in multifaceted cultural and organisational programmes to strengthen patient safety. It cannot be assumed that the introduction of a checklist will automatically lead to improved communication and clinical processes.