Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical...

Area of Science:

• Healthcare Management
• Patient Safety
• Surgical Innovation

Background:

• The Surgical Safety Checklist (SSC) aims to reduce surgical mortality and morbidity but faces implementation challenges globally.
• Understanding the integration of complex interventions like Pass The Baton (PTB) is crucial for improving SSC adherence.

Purpose of the Study:

• To utilize Normalisation Process Theory (NPT) to analyze the integration of the Pass The Baton (PTB) intervention for the Surgical Safety Checklist (SSC).
• To identify factors influencing the successful adoption and routine use of the SSC in surgical settings.

Main Methods:

• A longitudinal multi-method study involving surveys (NoMAD) and interviews with surgical teams.
• Implementation of PTB included change champions, audit, feedback, education, and prompts.
• Analysis used descriptive statistics for surveys and inductive content analysis based on NPT for interviews.

Main Results:

• High perceived value (77.6%) and continued use (86.2%) of PTB were reported by survey respondents.
• Integration into workflows was seen as feasible (77.6%), with potential for improvement through feedback (82.8%).
• Nurses and physicians had mixed views on coherence; buy-in depended on individual investment and adaptability of PTB.

Conclusions:

• Workarounds and flexible co-construction in implementation strategies can facilitate the normalization of interventions like PTB in surgical practice.
• Adapting interventions to improve team communication is key to the successful integration of the Surgical Safety Checklist.