| Sumario: | Introduction Effective communication is crucial for patient safety in surgery, as many adverse events result from human and teamwork-related factors. To address this, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSC), although its implementation and compliance vary across healthcare settings. Aim To explore the barriers and facilitators to implementing the WHO's SSC at a tertiary-level hospital in Croatia, a country with a publicly funded universal healthcare system. Methods Focus group- based study which used Graneheim and Lundman's qualitative content analysis approach was conducted. We used purposive sampling to gather participants who were representative of the usual surgical team: nurses, residents, anaesthesiologists and surgeons. Aside from this requirement, we set no specific inclusion or exclusion criteria. We conducted 6 focus groups (2 with nurses, 2 with residents, 1 with anaesthesiologists and 1 with surgeons) with 29 participants. The nurses were all female, the residents and surgeons were all male, and anaesthesiologists were mostly male (60%). Most participants had at least a bachelor's degree (93%). The focus groups were held in person at the hospital's Department of Surgery in Croatia and were conducted in the local language, based on a predeveloped topic guide. Results Our analysis revealed two distinct themes that were fundamentally independent of each other. The first concerned within- team hierarchies and relationships that prevented the SSC from being used as intended, while the second was related to a diverse set of resource and logistical constraints that had existed before the implementation of the SSC. Conclusion Understanding the barriers faced by healthcare providers is crucial in designing training programmes that could help integrate the SSC into routine surgical practice. Our findings highlight the importance of actively including members of the surgical team in the implementation of the SSC and implementing interventions for improving within- team communication.
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