Reasons for the persistence of adverse events in the era of safer surgery - a qualitative approach

Kaderli, Reto; Seelandt, Julia C.; Umer, Melika; Tschan, Franziska; Businger, Adrian P. (2013). Reasons for the persistence of adverse events in the era of safer surgery - a qualitative approach. Swiss medical weekly, 143, w13882. EMH Schweizerischer Ärzteverlag 10.4414/smw.2013.13882

SMW, Kaderli.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (442kB) | Preview

OBJECTIVE We sought to evaluate potential reasons given by board-certified doctors for the persistence of adverse events despite efforts to improve patient safety in Switzerland. SUMMARY BACKGROUND DATA In recent years, substantial efforts have been made to improve patient safety by introducing surgical safety checklists to standardise surgeries and team procedures. Still, a high number of adverse events remain. METHODS Clinic directors in operative medicine in Switzerland were asked to answer two questions concerning the reasons for persistence of adverse events, and the advantages and disadvantages of introducing and implementing surgical safety checklists. Of 799 clinic directors, the arguments of 237 (29.7%) were content-analysed using Mayring's content analysis method, resulting in 12 different categories. RESULTS Potential reasons for the persistence of adverse events were mainly seen as being related to the "individual" (126/237, 53.2%), but directors of high-volume clinics identified factors related to the "group and interactions" significantly more often as a reason (60.2% vs 40.2%; p = 0.003). Surgical safety checklists were thought to have positive effects on the "organisational level" (47/237, 19.8%), the "team level" (37/237, 15.6%) and the "patient level" (40/237, 16.9%), with a "lack of willingness to implement checklists" as the main disadvantage (34/237, 14.3%). CONCLUSION This qualitative study revealed the individual as the main player in the persistence of adverse events. Working conditions should be optimised to minimise interface problems in the case of cross-covering of patients, to assure support for students, residents and interns, and to reduce strain. Checklists are helpful on an "organisational level" (e.g., financial benefits, quality assurance) and to clarify responsibilities.

Item Type:

Journal Article (Original Article)


07 Faculty of Human Sciences > Institute of Psychology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Kaderli, Reto Martin; Umer, Melika and Tschan, Franziska


100 Philosophy > 150 Psychology
600 Technology > 610 Medicine & health




EMH Schweizerischer Ärzteverlag




Lilian Karin Smith-Wirth

Date Deposited:

19 May 2014 08:48

Last Modified:

05 Dec 2014 10:12

Publisher DOI:


PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback