Carrying out the SSC itself is reported to take 2 to 3 minutes (Haynes, et al., 2009; WHO, 2009). According to Fourcade, et al. (2012), surgical teams perceive that the SSC takes too long to complete and might generate delays. Papaconstantinou, et al. (2013) evaluated the impact of the SSC on time efficiencies by reviewing a total of 35,570 operations to identify the negative impact of the checklist on OR efficiency. They concluded that the implementation of the SSC does not negatively influence operative efficiency on an institutional level and, therefore, should not be regarded as a barrier to its effective use. Rather, the SSC can reduce delays of surgical procedure by improving ...view middle of the document...
The problem occurs when the organization is set up to maximize efficiency and productivity without allocating enough personnel resources (Cuschieri, 2006). In the qualitative design study of Alfredsdottir & Bjornsdottir (2008), nurses mentioned that the schedule for operations is too tight, and the pace must be kept up at all costs. To achieve more in less time appears to be an organizational expectation; however, to maintain efficiency and patient turnaround in the OR was considered to be unrealistic because of the nursing shortage (Gillespie, et al., 2010b). The surgical procedure cannot be hurried; nonetheless, the work processes are timed, and, eventually, nurses feel pressured toward shortening the time for preparation of operation, which could bring about the opportunity for errors (Alfredsdottir & Bjornsdottir, 2008).
In addition, teamwork can be interrupted by distraction, which is illustrated as unpredictability and frequent changes in team composition (Silén-Lipponen, et al., 2004). Constant membership turnover could include a change of service, and consequently concern for patient safety emerged, due to the inability of the less experienced team members to function properly (Silén-Lipponen, et al., 2005). It is not uncommon that some teams are under-staffed or undertrained in the OR (Alfredsdottir, & Bjornsdottir, 2008). As Finn (2008) stated, the composition and size of teams vary in accordance with the surgical procedure, daily workload, available staff and skill distribution within the OR as a whole. Therefore, the OR environment makes teamwork sometimes unpredictable, especially during on-call hours or emergency, as the work is unexpected, and teams are established rapidly and on an unscheduled basis (Silén-Lipponen, et al., 2004).
The SSC established safety strategy in the OR is seen to be advantageous to OR efficiency as well as the safety of patients undergoing surgery. However, the unpredictability and variability of the composition of teams could impede not only efficiency but also safety. As there is a lack of evidence regarding when and how changes in the OR team’s composition affect patient care (Silén-Lipponen, et al., 2004), further study in different settings such as day surgery or night surgery may be required, to identify how to keep the teams more stable in the OR. Organizational/institutional issues appear to be at play in teamwork. Patient safety should be made a top priority of teamwork, even at the expense of efficiency; however, this is often disrupted by the contextual conditions, such as conflicting priorities, staff shortages (Cuschieri, 2006; Schimpff, 2007; Gillespie, et al., 2010b), increased workloads and time pressure (Alfredsdottir & Bjornsdottir, 2008), which are beyond a team’s capacity.
Teamwork as a contributing factor to patient safety
In the study of eight international cities’ patients that participated in the WHO’s campaign, the SSC intervention decreased the rate of death at all sites...