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This scoping review considered studies published from 2009 onwards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction<\/jats:title>\n                    <jats:p>Information on the objective, method and findings addressing improvement strategies employed to strengthen the safety climate in the surgical centre was retrieved. The findings are presented in tables and in a qualitative thematic summary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 26 studies were analysed, published between 2009 and 2024, with the USA as the country of origin of the publications with the highest number (11 studies). As for the methodological approach, intervention and quasi-experimental studies stand out. When the studies in this review were mapped, strategies that strengthened the safety climate in the operating room were identified and grouped into two main axes that are interrelated: communication tools and training programmes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>It is evident that the implementation of tools that promote communication and training programmes enhances safe surgical care, as they contribute substantially to the domains of the safety culture. The use of communication protocols in the operating room is recommended as a perioperative safety tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      This scoping review adhered to a protocol previously published in this journal and that is registered on the Open Science Framework website (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/zg8nu\/\">https:\/\/osf.io\/zg8nu\/<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109055","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:15:38Z","timestamp":1767762938000},"page":"e109055","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation strategies by leaders and health professionals to improve the safety climate in the operating room: a scoping review"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-8753","authenticated-orcid":false,"given":"Rosilene","family":"Alves Ferreira","sequence":"first","affiliation":[{"name":"Faculty of Nursing, State University of Rio de Janeiro, Rio de Janeiro, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-2377","authenticated-orcid":false,"given":"Eduardo Jos\u00e9 Ferreira","family":"Santos","sequence":"additional","affiliation":[{"name":"Polytechnic University of Viseu, School of Health, Viseu, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal"},{"name":"Portugal Centre for Evidence Based Practice (PCEBP): A JBI Centre of Excellence, Coimbra, Portugal"},{"name":"RISE-Health, Porto University, Porto, Portugal"}]},{"given":"Olga Maria Pimenta Lopes","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"RISE-Health, Porto University, Porto, Portugal"},{"name":"Nursing School of the University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0656-1680","authenticated-orcid":false,"given":"Danielle Mendon\u00e7a","family":"Henrique","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, State University of Rio de Janeiro, Rio de Janeiro, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4330-953X","authenticated-orcid":false,"given":"Flavia Giron","family":"Camerini","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, State University of Rio de Janeiro, Rio de Janeiro, Brazil"}]},{"given":"Andressa Aline Bernardo","family":"Bueno","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, State University of Rio de Janeiro, Rio de Janeiro, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8011-378X","authenticated-orcid":false,"given":"Soraia Cristina","family":"de Abreu Pereira","sequence":"additional","affiliation":[{"name":"RISE-Health, Porto University, Porto, Portugal"},{"name":"Nursing School of the University of Porto, Porto, Portugal"},{"name":"Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal"}]},{"given":"Vivian","family":"Schutz","sequence":"additional","affiliation":[{"name":"University of Central Florida, Orlando, Florida, USA"}]},{"given":"Marcia Valeria","family":"Rosa Lima","sequence":"additional","affiliation":[{"name":"Fluminense Federal University, Niter\u00f3i, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6089-9670","authenticated-orcid":false,"given":"Cintia Silva","family":"Fassarella","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, State University of Rio de Janeiro, Rio de Janeiro, Brazil"}]}],"member":"239","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026010621151864000_16.1.e109055.1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jhsa.2017.11.006","article-title":"Patient Safety Movement: History and Future Directions","volume":"43","author":"Lark","year":"2018","journal-title":"J Hand Surg Am"},{"key":"2026010621151864000_16.1.e109055.2","unstructured":"National Steering Committee for Patient Safety . 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