Operating theatres data, since April 2014. Sampson (2018)24 summed


up healthcare mistakes by stating that, at any point during patient treatment, a mistake can occur. These often come down to human error. We should learn from our mistakes, but sometimes they are unavoidable, and therefore should be seen as a learning curve, as opposed to a disastrous event for the Trust. Ultimately, there is still much more research needed to understand if these contributing factors result in patient harm, as well as understanding if a further second time out would be of benefit.


Delphi study methodology Thinking about the second round of the Delphi study, a review of the current practice and researched literature will act as the catalayst for further enquiry. The approach to this research was based on three Delphi rounds where twenty-two NHS England Trust expert theatre managers, matrons and educators were asked for their opinion on a series of questions. Of the 223 NHS Trusts in England (King’s Fund, 2021),27


only 157 NHS Trusts have operating


theatres (Supporting Facilities Data, 2019/20 cited in NHS England, 2020).28


Across seven


separate regions, there are a total of 3,282 operating theatres. For the purposes of the Delphi study, a decision was made to purposefully reduce the number of Trusts and operating theatres. The total number of Trusts included in the


Delphi was reduced by twenty-one. This gave a new total of 136 Trusts with 2,918 operating theatres. The rationale for excluding 21 Trusts was the following reasons: a) Nine Trusts were not yet in existence between April 2015 – March 2020 at the point that LocSSIPs where first introduced.


b) Six Trusts were excluded as a result of only appearing to have one operating theatre, therefore meaningful data was difficult to ascertain.


c) Two of the Trusts are non-NHS. d) We removed the data from a further Trust because of a possible conflict of interest.


e) Three Trusts did not provide any contact details.


The Delphi study was sent to all participants on the 29 November 2022; all responses were received back on the 9 December 2022. Put simply, the intention for the Delphi study was to try to establish the level of compliance with the WHO surgical safety checklist, as well as identify any key themes and patterns from the emergent data. In total, 22 NHS England Trusts participated. The study was undertaken via Qualtrics, to


Team brief 3.85% Sign in 3.85% Time out/STOP moment 3.85% Sign out 3.85% De-brief 69.23% Check, stop, block 19.23%


Figure 5 – Which of the five steps (six if prep, stop, block inc.) are commonly missed


ensure anonymity. This equates to 16% of NHS England Trusts that have operating theatres as part of their routine or emergency patient services. This study took a representative sample. The authors had no influence on the selection of participants; it was a completely random selection. This also meant that there was no scope for the author to influence the sample and therefore the sample was not biased. The sample of staff was determined by the


participants volunteering from across NHS England. It can therefore be argued that it is possible to generalise the results for the entire research population, i.e. NHS England. Denscombe (2021)29


writes that “the basic


principle of sampling is that it is possible to produce accurate findings without the need to collect data from each and every member of a research population”. There was a range of hierarchical agenda-for-change bands, age and professional qualifications held, i.e., RGN or ODP.


Results Some of the Delphi round one questions required further drilling down to gather an understanding of the responses. For example: ‘Why is the debrief the biggest step missed?’ At the launch of the WHO checklist in 2009 (WHO Patient Safety, 2009, cited in Clark et al, 2012)30


, there were only three


steps. These were: sign-in; time-out; and sign-out. It wasn’t until December 2010 (Shah, 2011)10


that


the three-point checklist was converted to the five steps with the addition of the briefing and debriefing. In 2010, the Nottingham group devised the original ‘Stop-Before-You-Block’ campaign (SALG, 2021).31


In 2015, wrong-sided nerve blocks were classified by NHS England as never


Time 17.24% Staff attitude 27.59% Culture 18.97% Lack of leadership 15.52% Communication 15.52% Other 5.17%


Figure 6 – perceived barriers as to why the SSC does not get completed.


events. This is now an additional anaesthetic safety check/step for when nerve blocks are administered during regional anaesthesia. The name has now changed to ‘Prep, Stop, Block’ (Haslam, Bedforth and Pandit, 2021).32 The Delphi study wanted to ascertain if all five/six steps are always undertaken – but, if steps are missed, which one/s and why? The aim was to understand what corrective action/s could be put in place and, more importantly, learn from Trusts, as this will ensure cyclical learning occurs. All the SSC steps are as important as each other, as they are undertaken at a point in time during the intra-operative phase to ensure the safety of the patient and the smooth running of the session. They act as reminders to all the team, to ensure defined tasks are completed. The next question that required further


exploration included: ‘What can NHS Trusts do to break down the perceived barriers?’ (see figure 3) ‘Barriers’ is a ‘loose’ term and can mean many things. For the purpose of this research, the barriers wanting to be understood relate to implementation and human factors. The early literature suggests that, for successful implementation of the SSC, and to realise the full benefits, the primary challenge is one of culture (Mahajan, 2011).33


Mahajan found that leadership


was required for successful implementation of the surgical safety checklist. Zuckerman et al (2012)34


communication was required for successful implementation. An orthopaedic study in the UK, by Sewell et al (2011) – cited in Collins et al (2014)35


Patel et al (2014)37


, Treadwell, Lucasr and Tsou (2014)36 – showed the importance


of education and training in changing staff March 2023 I www.clinicalservicesjournal.com 21 also found that a shared vision of active


, and


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