| Perceptions of checklist and patient safety
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Demonstration of the checklist by the teaching team to address concerns about time consumption Extensive presentation of the evidence based on the initial lecture portion and offering of paper copies of the original research articles to participants
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Workflow adjustments
Individual and team workflow adjustments needed |
Multidisciplinary simulation and discussion to address concerns of workflow interruption Participants themselves playing different roles in simulation to encourage teamwork for minimal workflow interruption
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| The checklist
| Extensive, in-depth group discussion and adaptation by the hospital team to eliminate ambiguous questions, duplication and encourage buy-in and ownership |
| The implementation process
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Ensuring skills such as counting needles, sponges and instruments were taught Inviting entire surgical teams and asking for mandatory attendance, as well as deferring of non-emergency cases encouraged all operating room team members to participate in the training. Group discussions regarding ‘who’ instigates the checklist were ensured Attendance of surgeons and hospital leadership expected; dinner out with key leadership on the second night, to give them an opportunity to ask questions or clarify things in a small, informal setting
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| The local context
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Collaboration with government and local providers during the project design and implementation phase of the programme Invitation and collaboration with hospital directors and regional ministers of health for the initial presentation of evidence to ensure buy-in and ongoing support after team departure General public acknowledgement by the teaching team that change is difficult, and there may be resistance; however, patient safety is in the hands of the entire operating room team Donation of pulse oximeters when needed; adaptation of other questions to hospital-specific equipment
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