Operating theatres


perceptions. Treadwell, Lucasr and Tsou (2014)36


found that barriers included surgeon


resistance to changing habits, awkwardness of self-introductions and steep interpersonal hierarchy and, finally, Gillespie et al ’s (2018)8 Australian study stated that the most significant barriers to using the SSC, as recommended, were: workflow, limited knowledge about timing, content of checks, a lack of clinical leadership and dissonant attitudes. The WHO checklist has been in circulation for


many years. Does the NHS need to revise how the surgical safety checklist is undertaken? The purpose of this question is to ascertain from the patient safety experts, completing the Delphi Study, if a new approach is required to tackle the number of intra-operative never events reported annually. 42.86% of respondents felt that training should be mandated and be annual. LocSSIPs have been introduced, but the number of never events reported have not dramatically reduced. Does the Health and Safety Investigation Branch, the Care Quality Commission and indeed NHS England need to have a re-think of how a reduction of never events can be achieved, bearing in mind that we are dealing with humans that make errors, and zero harm may not always be possible? For any system or process to work, training should occur. Sewell et al ’s orthopaedic study, in the UK,35-37


suggested the importance


of education and training in changing staff perceptions; 81.81% of respondents felt that the NHS needs to revise how the SSC is undertaken. With regard to whether all five steps are completed, figure five shows which steps are commonly missed. As the literature supports, there could be


many reasons or perceived barriers as to why the surgical safety checklist is not always completed. Mahajan (2011)33


also found that leadership


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


found that a shared vision of active


communication was required for successful implementation. Sewell et al ’s orthopaedic study in the UK (2011), cited in Collins et al (2014), Treadwell, Lucasr and Tsou (2014), and Patel et al (2014),35-37


showed the importance of education


and training in changing staff perceptions. Treadwell, Lucasr and Tsou (2014)36


found that


barriers included surgeon resistance to changing habits, awkwardness of self-introductions and steep interpersonal hierarchy and, finally, Gillespie et al ’s Australian study8


stated that the


most significant barriers to using the SSC, as recommended, were workflow, limited knowledge about timing, content of checks, a lack of clinical leadership and dissonant attitudes. The study highlighted this; the feedback was spread across


22 www.clinicalservicesjournal.com I March 2023


Strongly agree 13.64% Agree 22.73% Somewhat agree 31.82% Neither agree nor disagree 13.64% Somewhat disagree 4.55% Disagree 13.64% Strongly disagree


Figure 7 – Lack of direction/senior leadership


Strongly agree 18.18% Agree 22.73% Somewhat agree 38.36% Neither agree nor disagree 9.09% Somewhat disagree 13.64% Disagree Strongly disagree


Figure 8 – Is there a lack of MDT working?


several headings, but the debrief was the most common step missed. How do theatre staff ensure cyclical learning occurs, if there is no debrief? Figure six details the perceived barriers as to why steps are missed.


Leadership for the successful implementation


of the SSC is key, as Conley, Singer and Edmondson (2011, cited in Barimani et al, 2020)14 concluded, following a study of five hospitals. Engagement of leadership was seen as a key factor in the success of the SSC adoption. Having leaders actively promote the SSC was deemed to be successful. Therefore, hospital leaders need to work on all staff’s perception and resistance to change, by educating staff that the hospital’s priority is one of patient safety (Gillespie et al, 20106


, and Conley, Singer and Edmondson 2011,


cited in Barimani et al, 2020).14 Close et al ’s (2017)20


study findings showed


that hospital leadership is critical and must move beyond formal office meetings. The second Delphi Study sought to understand if senior leaders in NHS organisations support, encourage and lead to ensure the SSC is adopted. The multidisciplinary team in theatres may consist of surgeons, anaesthetists, anaesthetic associates, operating department practitioners, nurses, support workers, assistant theatre practitioners or nurse associates, imaging staff, perfusionists, surgical care practitioners, surgical first assistants and other disciplines, depending upon the surgery being performed. An American study in Colorado Springs, stated that their human factors training was based on the CRM programmes that were championed by the airline industry in the 1970s, as the same attitudes were present in the operating rooms of today, such as theatre staff finding it hard to


question decisions made by the surgeon, even though the decision may lead to patient harm. Another study in the US, by Sewell et al, found that the introduction and use of the SSC could promote a shift in the operating room culture by flattening the hierarchical reporting structure, enhancing teamwork, and emphasising that all members of the team are responsible for patient safety.35-37


The study also reported that


77% of users thought the checklist improved team communication; this figure was 70% in a study by Kearns et al (2011), cited in Treadwell, Lucasr, and Tsou (2014).36 Staff shortages across the NHS reported by Deakin (2022)38


stand at 110,000; this does


not include primary care. NHS Funding (2022)39 reported a similar number of 132,1139 vacancies as of 30 June 2022. The Care Quality Commission reported similar numbers in October 2022, but added that the vacancy rate was 9.7%. London has reported the highest vacancy rate, with the North-East and Yorkshire consistently having the lowest. The regulator, CQC, (2022)40


stated


that health and care leaders need to recruit the equivalent of the population of Newcastle. Figure nine highlights the number of Full Time Equivalent (FTE) vacancies in the NHS across the seven regions between January and March 2022. A report in the press (The Star, 2022),41


by a


concerned whistle blower at a large teaching hospital in Sheffield, stated that: “operations are routinely being done with too few nurses and staff often have too little experience. Most days theatres run on three staff and, in some cases, two if a staff member takes a break”. The next question sought to understand


if operating theatres are experiencing staff shortages in theatres that may directly impact on patient safety. However, the response from


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