Patient safety culture, teamwork, and observed perioperative safety compliance in a high-volume surgical unit
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Perioperative safety checklists standardize critical actions, but reliable completion depends on the surrounding work system and team behavior. We conducted a prospective observational analytic study from April to May 2026 in the central surgical unit of a high-volume public teaching referral hospital in Indonesia to examine whether patient safety culture and teamwork were associated with directly observed perioperative safety compliance and whether teamwork mediated the culture-compliance relationship. Patient safety culture was measured with the Hospital Survey on Patient Safety Culture 2.0, teamwork with a 35-item TeamSTEPPS Teamwork Perceptions Questionnaire research adaptation, and compliance by direct role-based observation using a 45-item checklist derived from the AORN Comprehensive Surgical Checklist. Eighty of 92 recruited professionals contributed 240 person-operation observations across 50 operations. Overall compliance was 74.75%, with sign-out lowest at 70.68%. Patient safety culture was associated with teamwork (β = 0.590; 95% CI 0.510-0.770) and directly with compliance (β = 0.407; 95% CI 0.187-0.712). The teamwork-compliance coefficient was positive (β = 0.285; p = 0.046), but the prespecified percentile 95% CI included zero (−0.045 to 0.517). The indirect effect through teamwork was not supported (β = 0.168; p = 0.079). These findings support a system-level interpretation of perioperative safety and identify learning-oriented responses to error, situation monitoring, and sign-out fidelity as measurable targets for future improvement efforts.
Author summary
Surgical safety checklists are intended to make critical safety actions reliable, but their effectiveness depends on how teams and organizations work. We studied 80 perioperative professionals in a high-volume Indonesian teaching hospital and linked their perceptions of patient safety culture and teamwork with directly observed compliance across 240 person-operation observations. Stronger safety culture was associated with better teamwork and higher observed compliance. Teamwork itself showed a positive but statistically inconsistent association with compliance and did not explain the full culture-compliance relationship. The findings suggest that quality improvement should combine learning-oriented responses to error, active situation monitoring, and stronger sign-out execution rather than relying on teamwork training alone.
