Factors Associated with Effective Implementation of a Surgical Safety Checklist

项目摘要/摘要 2009年，严格遵守世卫组织手术安全清单，这是一种廉价和 易于使用的工具，被发现将30天的死亡率从1.5%降低到0.8%，总体上 从坦桑尼亚到美国的八家不同医院的并发症从11%到7%不等。 从那时起，93个国家的3200家医院采用了这份清单。带来的好处 然而，检查清单取决于个别医院有效执行该清单的能力。 实施是采用组织引入创新的过程 并鼓励它们的使用。实施可能会也可能不会有效地产生一致性， 高质量利用一项目标创新。拟议的研究将审查执行情况 在一大批美国和国际医院的流程中，并将确定支持因素 有效执行的能力。这项研究还将检验有效的 团队合作的实施，作为清单如何改进结果的解释。 为了实现这些目标，将从75个外科单位收集数据。数据在 将从实施负责人和外科医生处获得实施流程核对表 使用通过借鉴以前的工具和初步研究而开发的调查。数据在 实施有效性、团队合作和核对表结果将通过直接 护士经理、病人安全官和护士对手术过程的观察。 横向和纵向比较将使执行进程与有效 团队合作和核对表成果的实施和有效实施。 这项研究将在理论、方法、实践和研究方面做出重大贡献 实施科学领域。我们将为创新理论做出贡献 实施和团队合作，证明有效的清单实施可以 导致良性循环，以可持续改进的方式影响团队活力 实施效果，从而带来创新的好处。我们将采用小说 可广泛应用的评估工具和培训方法，以增加 有效执行清单，并在今后对执行类似清单的研究中 创新。出于实际目的，我们将确定特定的背景因素和活动， 导致有效实施核对表，可供其他组织效仿 实施清单和类似的创新。

PROJECT SUMMARY/ABSTRACT In 2009, strict adherence to the WHO Surgical Safety Checklist, an inexpensive and easy-to-use tool, was found to reduce 30-day mortality from 1.5% to 0.8% and overall complications from 11% to 7% in eight diverse hospitals from Tanzania to the United States. Since then, the Checklist has been adopted by 3,200 hospitals in 93 countries. The benefits of the Checklist, however, depend upon the individual hospitals' ability to implement it effectively. Implementation is the process by which adopting organizations introduce innovations and encourages their use. Implementation may or may not be effective at producing consistent, high-quality utilization of a target innovation. The proposed study will examine implementation processes in a large group of US and international hospitals and will identify factors supportive of effective implementation. The study will also examine the relationship of effective implementation to teamwork, as an explanation for how the Checklist improves outcomes. In order to achieve these aims, data will be collected from 75 surgical units. Data on Checklist implementation processes will be obtained from implementation leaders and surgeons using a survey developed by drawing on prior instruments and preliminary research. Data on implementation effectiveness, teamwork, and Checklist outcomes will be obtained by direct nurse manager, patient safety officer and circulating nurse observations of surgical procedures. Cross-sectional and longitudinal comparisons will relate implementation processes to effective implementation and effective implementation to teamwork and Checklist outcomes. This study will make significant theoretical, methodological, practical and contributions to the field of implementation science. We will contribute to theory about innovation implementation and teamwork by demonstrating that effective Checklist implementation can lead to a virtuous cycle, affecting team dynamics in ways that can continuously improve implementation effectiveness and thus the benefits of the innovation. We will employ novel evaluation tools and training methods that can be applied broadly to increase the likelihood of effective implementation of the Checklist and in future studies of the implementation of similar innovations. For practical purposes, we will identify specific contextual factors and activities that lead to effective Checklist implementation, which can be emulated by other organizations implementing the Checklist and similar innovations.