Compliance of the WHO Surgical Safety Checklist Across Surgical Specialties: A Cross-Sectional Study in a Tertiary Care Hospital

Abstract

Background: The World Health Organization Surgical Safety Checklist is a standardized perioperative safety tool designed to reduce preventable surgical errors through structured communication and verification. Objective: To assess compliance with the WHO Surgical Safety Checklist across surgical specialties and identify staff-related and organizational predictors of perceived intraoperative outcome improvement. Methods: A descriptive cross-sectional study was conducted among 185 surgical team members working in selected operating rooms of a tertiary care hospital in Lahore, Pakistan. Data were collected using a structured self-administered questionnaire assessing demographics, checklist compliance, confidence, perceptions, barriers, and perceived outcomes. Descriptive statistics, cross-tabulation, chi-square testing, and multiple linear regression were used for analysis. Results: General Surgery was the largest specialty group (22.7%), and surgeons comprised 25.9% of participants. Most participants agreed that the checklist improves patient safety (76.8%), while 80.5% reported that proper use reduces intraoperative errors or near misses. Time Out was the most frequently skipped or rushed phase (33.0%). Confidence was significantly associated with compliance (χ²=17.42, p=0.0016). Regression analysis showed that SSC compliance score (β=0.45, p<0.001), staff confidence (β=0.32, p=0.004), perception score (β=0.27, p=0.008), years of experience (β=0.18, p=0.026), and organizational support (β=0.22, p=0.029) positively predicted outcome improvement, while workload showed a negative association (β=–0.15, p=0.035). Conclusion: SSC compliance was influenced by staff confidence, perception, experience, organizational support, and workload. Structured training, leadership reinforcement, and workflow optimization are needed to improve checklist adherence