Improving the safety of patient care is a top priority in the perioperative environment in order to minimize preventable deaths, post-surgical complications, and preventable adverse events.

Improved protocols (eg, checklists), practices (eg, infection control), and artifacts (eg, cognitive aids) can help.

For example the World Health Organization (WHO)’s Surgical Safety Checklist was developed to decrease errors and adverse events, and to improve surgeon, anesthesia provider and nurse teamwork and communication during surgery. The checklist aims to aid in adherence to protocol steps (such as confirming the patient’s name, procedure, and incision location) including anticipatory guidance (such as the key concerns for recovery and patient management) and anticipatory critical events (such as considering if there any patient-specific concerns).

However, in the complex perioperative environment, a broader perspective beyond implementing checklists to establish behavioral norms is needed to address safety culture. In addition to behavioral norms and artifacts, organizational safety culture is composed of assumptions about the nature of the workplace and its components as well as values about safety measured through perceptions and attitudes (ie, safety climate). Behavioral factors that prevent, respond to, or resolve safety issues not only help to improve safety outcomes but also to reinforce safety culture over time. Bisbey and colleagues highlight the importance of such enacting behaviors including a fair work environment with the ability to report near misses and errors without punishment, teamwork and collaboration across services and organizational levels to address safety problems, and effective communication between individuals, teams, and management. Bisbey and colleagues
 note that organizational, group or unit level, and individual enabling factors support workers to adopt the appropriate norms, values, and assumptions. Organizational level enabling factors include dimensions such as leader commitment and prioritization of safety as well as policies and resources for safety. At the group or unit level, factors such as cohesion and psychological safety influence safety culture. At the individual level, enabling factors including safety knowledge, employee sense of control, and individual commitment to safety impact safety culture are also important.

While there is an increasing interest in patient safety and in transforming culture in the perioperative environment, it is not clear what methods are being used to understand, assess, and influence safety culture and climate. Thus, this work seeks to uncover what instruments and measures are used to assess safety culture in the perioperative environment. It analyzes whether the measures support investigating enabling factors that create conditions conducive for safe behavioral norms, values, and assumptions and the enacting behaviors that support observing and learning from one’s own and others’ behaviors. The work investigates how these measures are applied in the baseline assessments and in interventions in the perioperative environment to enhance/support safety culture.