{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:56:38Z","timestamp":1790963798415,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T00:00:00Z","timestamp":1574035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T00:00:00Z","timestamp":1574035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T00:00:00Z","timestamp":1574035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100015759","name":"GE Foundation","doi-asserted-by":"crossref","award":["5R18HS024235-02"],"award-info":[{"award-number":["5R18HS024235-02"]}],"id":[{"id":"10.13039\/100015759","id-type":"DOI","asserted-by":"crossref"}]},{"name":"ELMA Philanthropies","award":["17-F0012"],"award-info":[{"award-number":["17-F0012"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Millions of patients worldwide suffer disability and death due to complications related to surgery. Many of these complications can be reduced by the use of the World Health Organization (WHO) Surgical Safety Checklist (SSC), a simple tool that can enhance teamwork and communication and improve patient safety. Despite the evidence on benefits of its use, introducing and sustaining the use of the checklist are challenging. We present a team\u2010based approach employed in a low\u2010resource setting in Tanzania, which resulted in high checklist utilization and compliance rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed reported data from facility registers supplemented by direct observation data by mentors to evaluate the use of the WHO SSC across 40 health facilities in two regions of Tanzania between January and December 2018. We analyzed the self\u2010reported monthly data on total number of major surgeries performed and proportion of surgeries where the checklist was used. We also analyzed the use of the SSC during direct observation by external mentors and completion rates of the SSC in a random selection of patient files during two mentorship visits between June and December 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the review period, the average self\u2010reported checklist utilization rate was 79.3% (11,564 out of 14,580\u00a0major surgeries). SSC utilization increased from 0% at baseline in January 2018 to 98% in December 2018. The proportion of checklists that were completely and correctly filled out increased between the two mentor visits from 82.1 to 92.8%, but the gain was significantly greater at health centers than at hospitals (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Health centers (which had one or two surgical teams) self\u2010reported a higher checklist utilization rate than hospitals (which had multiple surgical teams), i.e., 99.4% vs 68.8% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion and recommendations<\/jats:title><jats:p>Our findings suggest that Surgical Safety Checklist implementation is feasible even in lower\u2010resource settings. The self\u2010reported SSC utilization rate is higher than reported in other similar settings. We attribute this finding to the team\u2010based approach employed and the ongoing regular mentorship. We recommend use of this approach to scale\u2010up checklist use in other regions in the country as recommended in the Ministry of Health of Tanzania's National Surgical, Obstetric, and Anesthesia Plan (NSOAP).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05292-5","type":"journal-article","created":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T18:01:55Z","timestamp":1574100115000},"page":"689-695","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A Team\u2010Based Approach to Introduce and Sustain the Use of the WHO Surgical Safety Checklist in Tanzania"],"prefix":"10.1002","volume":"44","author":[{"given":"Augustino","family":"Hellar","sequence":"first","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopold","family":"Tibyehabwa","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Ernest","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Varallo","sequence":"additional","affiliation":[{"name":"Jhpiego Baltimore USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret Mary","family":"Betram","sequence":"additional","affiliation":[{"name":"Jhpiego Baltimore USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Jhpiego Baltimore USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geofrey","family":"Giiti","sequence":"additional","affiliation":[{"name":"Department of Surgery Catholic University of Health and Allied Sciences, Weill\u2010Bugando Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Kihundrwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Bugando Medical Center Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ntuli","family":"Kapologwe","sequence":"additional","affiliation":[{"name":"President's Office Regional Authority and Local Government Dodoma Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Drake","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremie","family":"Zoungrana","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alena","family":"Troxel","sequence":"additional","affiliation":[{"name":"Jhpiego Baltimore USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Lemwayi","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania Plot 72, Block 45B, Victoria, New Bagamoyo Road Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shehnaz","family":"Alidina","sequence":"additional","affiliation":[{"name":"Program in Global Surgery and Social Change Harvard Medical School Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Maongezi","sequence":"additional","affiliation":[{"name":"Ministry of Health Community Development, Gender, Elderly and Children Dodoma Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Makuwani","sequence":"additional","affiliation":[{"name":"Ministry of Health Community Development, Gender, Elderly and Children Dodoma Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Varallo","sequence":"additional","affiliation":[{"name":"Jhpiego Baltimore USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102012\u2010001797"},{"key":"e_1_2_11_3_1","unstructured":"NybergerK JumbamD DahmJet al. 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