A culture of safety is essential to the delivery of high-quality, safe healthcare. This scoping review including 34 studies found that patient safety culture scores were generally associated with reduced adverse event rates, but the authors note a paucity of research from primary care settings and low- and middle-income countries as well as a need for longitudinal studies using standardized measures to better examine this relationship.

This study assessed the impact of combined use of two surgical safety checklists on morbidity, mortality, and length of stay – the Surgical Patient Safety System (SURPASS) is used to address preoperative and postoperative care, and the World Health Organization surgical safety checklist (WHO SSC) is used for perioperative care.  In addition to existing use of the WHO SSC, the SURPASS checklist was implemented in three surgical departments in one tertiary hospital in Norway. Results demonstrated that combined use of these checklists was associated with reduced complications reoperations, and readmissions, but combined use did not impact mortality or length of stay.

… multidisciplinary risk management strategy. … Waehle HV, Haugen AS, Wiig S, et al. How does the WHO Surgical Safety …

Initial enthusiasm about the ability of the World Health Organization's surgical safety checklist to prevent harm was tempered by a subsequent study that failed to improve clinical or safety outcomes. The conflicting results of surgical checklist studies have led to concerns that checklists may lack effectiveness when care is of relatively high quality at baseline, and that poor implementation can hinder their use. In this study, the WHO checklist proved successful at improving safety outcomes when implemented across five surgical services at two academic hospitals in Norway. The checklist's success in this rigorously designed and analyzed study was likely attributable to the institution having followed a structured implementation process that had been previously demonstrated to improve safety culture in the operating room. The controversy around surgical safety checklists is discussed in a recent AHRQ WebM&M interview.

This focus group study of a surgical operating team uncovered challenges in implementing the WHO safe surgery checklist, such as time pressure. These findings may explain the gap between effective trials of checklists and results from observational studies.