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In all processes, there is an inherent risk of variability to occur. In the process of delivering healthcare, variability can occur as a result of an error or omission and compromise the quality of care or affect the safety of the health care consumer. Even though incident reporting, root cause analysis, use of checklists and other quality improvement methods are in wide-spread use, we may not be using these tools appropriately and therefore we are losing an opportunity to improve the quality of care. [ABSTRACT FROM AUTHOR]

Issue: Recently, quality tools have been promoted to improve patient safety and process efficiency in healthcare. While surgeons primarily focused on surgical issues, like infection rates or implant design, we introduced pre-admission and preoperative checklists in the early 2000s.Initial Assessment: To assess the efficiency of these tools in a neurosurgical department, we performed a survey of all spinal instrumentation patients operated in 2011 (n = 147). The results revealed several problems.Choice Of Solution: We consequently redesigned the checklists accompanied by flanking measures, such as written  and online accessible standards. Furthermore, the staff was trained to use the updated quality tools.Implementation: The measures were implemented in 2012.Evaluation: Results were re-evaluated in a second survey in 2013 (n = 162). We found that the use of pre-admission checklists significantly increased from 47 to 96%, while the use of preoperative checklists significantly decreased from 86 to 75%. Within the same period, the quality and completeness of the checklists did, however, increase, so that in 2013, 43% of the patients had a completely processed preoperative checklist, compared to 29% in 2011.Lessons Learned: The introduction of checklists alone did not in itself guarantee an improved workflow. The introduction must be accompanied by other measures, like written standards and regular training of employees. Otherwise, the positive effect wears off quickly. Nevertheless, we could show that the stringent application of quality tools can induce a sustainable change. Our data further suggest that the clear and traceable delegation of responsibilities is of high importance. [ABSTRACT FROM AUTHOR]

Background Previous research suggests that the World Health Organization Surgical Safety Checklist time-out reduces communication failures and medical complications and supports development of better safety attitudes. Previous research also indicates that different values can affect the implementation of interventions. Objective To investigate the actual usage of the checklist in practice and to catalogue deviations for the purpose of identifying improvements. Design Twenty-four surgical procedures were video recorded. The time-out was analysed quantitatively assessing compliance with a predefined observational protocol based on the checklist and qualitatively to describe reasons for non-compliance. Setting The operating unit of a Swedish county hospital. Main outcome measures Compliance with checklist items and the participation of different personnel groups. Activities were conducted during the time-out. Results Highest compliance was associated with patient ID, type of procedure and antibiotics; the worst with site of incision, theatre nurse team reviews and imaging information. Team member introductions occurred in half of the operations. Surgeons and the anaesthesia team dominated the time-out. Conclusion The checklist is not always applied as intended. The components that facilitate communication are often neglected. The time-out does not appear to be conducted as a team effort. It is plausible that the personnel's conception of risk and the perceived importance of different checklist items are factors that influence checklist usage. To improve compliance and involve the whole team, the concept of risk and the perceived relevance of checklist items for all team members should be addressed. [ABSTRACT FROM PUBLISHER]