Abstract
Thank you very much for your insightful letter about our article, “Reflections on the Complexity of Surgical Site Infection Prevention and Detection from and Organizational Lens” [1]. We appreciate the authors' global lens. It highlights the value of sharing experiences in perioperative improvement. We do agree that the World Health Organization (WHO) checklist is a key tool to use in improving operating room communication and surgical safety. However, we also believe that checklist use, in and of itself, is unlikely to achieve the improvements that we desire. Whether in the setting of the central line infection checklist or surgical safety checklist, effectiveness is modulated by safety culture [2–4]. Simply implementing a checklist has too often failed to translate into meaningful clinical outcomes [5].
It is essential that we work collectively in the perioperative setting to optimize teamwork and communication and promote a just culture. On evaluation of United States Safety Culture Survey Data from the Agency for Healthcare Research and Quality, operating rooms consistently have lower scores than other work areas in the hospital. Interventions to improve the culture—such as team training and programs to promote professionalism—should be implemented in conjunction with the WHO checklist [6,7]. Although ambitious, we remain hopeful that together we can improve safety culture in operating rooms around the world. Such a paradigm shift will translate into improved patient outcomes not just with regards to surgical site infections but even things beyond such as return to the operating room, functional outcomes, and death.