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Safety and team cultures in the operating room: using WHOBARS to understand clinician attitudes to participation in the Surgical Safety Checklist



A/Prof Jennifer Weller, Prof Alan Merry, A/Prof Simon Mitchell, Prof Ian Civil, Dr Jacqueline Hannam, Dr Jane Torrie, Dr Tanisha Jowsey, Dr Dan Devcich, Dr David Cumin, Derryn Gargiulo and Carmen Skilton.


What is this study about? 

The World Health Organisation (WHO) Surgical Safety Checklist is established in the operating room as a communication tool to promote sharing of important clinical information and more effective teamwork. However, variability in its administration is widely reported and incomplete administration has been linked to adverse patient events.

The patient safety team at the University of Auckland have developed and evaluated a novel tool to measure the quality of Checklist administration (WHOBARS). Our initial studies provide some evidence on the validity of the tool, when administered by medical students. In this study we will be seeking additional evidence on the WHOBARS tool, and the potential for its use by operating room team members. We will also be exploring operating room staff perceptions and attitudes towards the Checklist.

This is a mixed methods study comprising two phases:

1)     Self-ratings of OR teams members and two independent observers using the WHOBARS tool.

2)     Interviews with a small subset of participants (~10%) to explore attitudes towards teamwork and communication as this relates to participation in the Checklist.


Research questions

1) What is the inter-rater reliability associated with use of the WHOBARS?

2) What is the variation in perceived quality of administration of the Checklist between members of the OR team?

3) What is the robustness of self-ratings vs observer ratings for WHOBARS?

4) What is the perceived quality of engagement of OR team members with the administration of the Checklist?

5) What are the attitudes and opinions of OR staff to the Checklist?


Study aims

1.     To further evaluate inter-rater reliability among intended users of the instrument, across a range of surgical settings;

2.     To analyse variation in perceived quality of administration of the Checklist between members of the OR team (i.e. differences between the different professional groups);

3.     To examine the relationship between self-rated scores for WHOBARS and those made for the same cases by independent observers;

4.     To gather information concerning people’s perceptions of the quality of their OR team members’ engagement with the Checklist.


Previously published research