Paper: Surgical Safety Checklist - more than checking a box

Fabulous - the authors have published a study where the results show there's a problem. I've been harping on about the lack of negative studies for years. So well done to the authors.

Basically, they've done some follow up work to see how well used the surgical safety checklist is. No surprises to discover that is most cases only 4 of the 13 items were checked. They suggest there is a problem with the fidelity of implementation, and a poor dissemination strategy and implementation.

Fidelity really is key. There's no point in shouting from the rooftops that 100 hospitals are using a checklist, for example, if it is not being used as intended. The results will not be as good as the pilot study. The return on investment for the project will not be as good. And, who knows, in some programs, the results may actually be worse than if the program hadn't been disseminated.

Fidelity. Important.

Surgery. 2012 Jul 6. [Epub ahead of print]
Implementing a surgical checklist: More than checking a box.
Levy SM, Senter CE, Hawkins RB, Zhao JY, Doody K, Kao LS, Lally KP, Tsao K.

Where are the negative studies?

I've written about his before, but I am still concerned about the lack of will to share what doesn't work in quality improvement initiatives. I worry that improvement leaders are so concerned about telling their sponsors that the work is doing very well, that they can't face the less than successful projects. We all know we learn from mistakes - in fact one of the basic tents of quality improvement is the importance of testing and learning (from the good and the bad).

I keep threatening to start the Journal for Quality and Safety Initiative Learning/Mistakes/Failures/Messes.  When I figure the title I'll get it going.  Any suggestions?

Publishing negative studies is good for learning

Humans learn by making mistakes. When the mistakes of others are hidden then we all have to go over the same ground to discover the errors - a waste of time, in many cases. The issue of publishing negative studies is a bit one.  When I was researching my book "Why good practice doesn't spread" I could find no-one who was prepared to share, publicly, their experience of a large scale change project that did not achieve what it set out to do. They would talk in private and anonymously - but not openly.

One of my ambitions is to start the online Journal of Quality Improvement and Patient Safety Program Failures. I would love to be able to read about projects that went pear-shaped. I think I would learn more from them than from the ones which advertise greatness.

If you have ideas on what should be included in this Journal then please leave a comment on this blogpost or email me directly.

In the meantime if you want to read a few articiples and papers about the issue check out:
Increased calls for publishing negative clinical trial data
Publish or perish culture distorting research results
The importance of publishing negative results