Effect of a two-year national quality improvement program on surgical checklist implementation.

Mascherek, Anna C; Bezzola, Paula; Gehring, Katrin; Schwappach, David L B (2016). Effect of a two-year national quality improvement program on surgical checklist implementation. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 114, pp. 39-47. Elsevier, Urban & Fischer 10.1016/j.zefq.2016.04.003

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Use of the surgical checklist in Switzerland is still incomplete and unsatisfactory. A national improvement program was developed and conducted in Switzerland to implement and improve the use of the surgical safety checklists. The aims of the implementation program were to implement comprehensive and correct checklist use in participating hospitals in every patient and in every surgical procedure; and to improve safety climate and teamwork as important cultural context variables. 10 hospitals were selected for participation in the implementation program. A questionnaire assessing use, knowledge, and attitudes towards the checklist and the Safety Climate Survey were conducted at two measurement occasions each in October/November 2013 and January/February 2015. Significant increases emerged for frequency of checklist use (F(1,1001)=340.9, p<0.001), satisfaction (F(1,1232)=25.6, p<0.001), and knowledge(F(1,1294)=184.5, p<0.001). While significant differences in norms (F(1,1284)=17.9, p<0.001) and intentions (F(1,1284)=7.8, p<0.01) were observed, this was not the case for attitudes (F(1,1283)=.8, n.s.) and acceptance (F(1,1284)=0.1, n.s.). Significant differences for safety climate and teamwork emerged in the present study (F(1,3555)=11.8, p<0.001 and F(1,3554)=24.6, p<0.001, respectively). However, although statistical significance was reached, effects are very small and practical relevance is thus questionable. The results of the present study suggest that the quality improvement program conducted by the Swiss Patient Safety Foundation in 10 hospitals led to successful checklist implementation. The strongest effects were seen in aspects concerning behaviour and knowledge specifically related to checklist use. Less impact was achieved on general cultural variables safety climate and teamwork. However, as a trend was observable, these variables may simply need more time in order to change substantially.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Schwappach, David


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Elsevier, Urban & Fischer




Doris Kopp Heim

Date Deposited:

02 Feb 2017 12:16

Last Modified:

11 Sep 2017 13:40

Publisher DOI:


PubMed ID:


Additional Information:

Mascherek & Schwappach contributed equally to this work.

Uncontrolled Keywords:

Chirurgische Checkliste; Einstellungen; Fragebogenerhebung; Implementierungsprogramm in der Schweiz; Sicherheitsklima; Surgical safety checklist; attitudes; implementation program Switzerland; safety climate; survey data





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