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Table 3 Barriers for guideline adherence (75 unique barriers) ranked in Barriers Top-3 (N = 158 in total)

From: Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

  Category Barrier 1st place
N (%)
2nd place
N (%)
3rd place
N (%)
  Intervention characteristics   6 (8.7) 3 (5.6) 1 (2.9)
1   Lack of scientific evidence 2 0 0
2   Complexity—unclear/ambiguous guidelines 2 0 0
3   Complexity—the guidelines are too extensive 1 0 0
4   Risk for the patient 1 0 0
5   Complexity—the guidelines are too detailed 0 1 0
6   Complexity—the guidelines contain many actions to carry out 0 1 0
7   Patient unfriendly guidelines 0 1 0
8   Complexity—the guidelines contain many stop moments 0 0 1
  Societal context   0 (0.0) 0 (0.0) 0 (0.0)
  Implementation characteristics   0 (0.0) 2 (3.7) 0 (0.0)
9   Being exposed too late to implementation efforts 0 2 0
  Organizational characteristics   27 (39.1) 23 (42.6) 14 (40.0)
10   Lack of time/time pressure 13 8 5
11   Workload 4 1 0
12   IT 1 3 2
13   Relevant information is missing, incomplete, or wrong 1 2 1
14   Organizational preconditions—preparations not adequately executed 0 2 0
15   Staff—capacity/lack of personnel 1 0 1
16   Organizational preconditions—a large group has to do the same thing at the same time 1 0 0
17   Staff—turnover of personnel 1 0 0
18   Logistics 1 0 0
19   Availability of resources and materials 1 0 0
20   Impossibility to meet all requirements within the current organization 1 0 0
21   Capacities 1 0 0
22   Organization of care processes 1 0 0
23   Unclear who is responsible for what; in case of shared responsibility, no one feels responsible 0 1 0
24   Organizational complexity 0 1 0
25   Prioritizing 0 1 0
26   Pressure to run production/finish surgeries on time 0 1 0
27   Lack of decisional power 0 1 0
28   Guests not aware of hospital—specific implementation of the guidelines 0 1 0
29   Organizational preconditions—nursing preparations not carried out 0 0 1
30   Too many communication lines 0 0 1
31   Low standard of working procedures 0 0 1
32   Too bureaucratic 0 0 1
  Social context   11 (15.9) 6 (11.1) 3 (8.6)
33   Culture 3 1 0
34   Collaboration (by nurses) 2 0 0
35   It is not accepted that the perioperative process is stopped or slowed down because some earlier stop moments are not (correctly) performed 1 0 0
36   Being overruled by doctors 1 0 0
37   Absence of anesthesiologist during sign-out 1 0 0
38   The surgeon as initiator for performance of the time-out and sign-out 1 0 0
39   Not taken seriously or involved in the TOP by the rest of the team 1 0 0
40   Lack of initiative of the team 1 0 0
41   Lack of support 0 1 1
42   Collaboration by some surgeons 0 1 0
43   Having to appeal people 0 1 0
44   Inefficient teamwork/people have different interests when working in shifts 0 1 0
45   Pressure by surgeons to start the surgery, while the time-out is not listed yet 0 1 0
46   Opposition by colleagues 0 0 1
47   Social pressure 0 0 1
48   Communication problems 0 0 1
  Professional characteristics   9 (13.0) 13 (24.1) 3 (37.1)
49   Attitude (of especially doctors) 2 0 1
50   Opinions—too excessive 2 1 0
51   Behavioral routines 0 2 0
52   Opinions—adherence to the guidelines may create a wrong sense of safety (i.e. hidden unsafety) by weakening independent thinking and responsibility taking 0 2 0
53   Awareness and knowledge about the importance and purpose 0 1 2
54   Behavior 1 1 0
55   Opinions—customization is preferred over standardization 1 0 0
56   Opinions—in some situations it makes totally no sense to apply the guidelines 1 0 0
57   Unclear handwriting 1 0 0
58   Opinions—finding it not useful to repeat things too often 0 1 0
59   Forgetting 0 1 1
60   Consideration for the wishes of the patient/perceiving patient discomfort 0 1 1
61   Concerns about whether the use of checklists promotes a mentality of just ticking boxes 0 1 0
62   Embarrassment toward the patients by asking several times the same question 0 1 0
63   Common sense 0 0 1
64   Motivation 0 0 1
65   Indifferent following of procedures 0 0 1
66   Self-overestimation 0 0 1
67   Personality 0 0 1
68   Lack of interest 0 0 1
69   Rationalities to allow deviant behavior (e.g. not following guidelines will not harm patients) 0 0 1
70   Own interpretation 0 0 1
  Patient characteristics   11 (15.9) 4 (7.4) 3 (8.6)
71   Emergency patient 9 2 2
72   Patient ability/cognitive abilities 1 1 0
73   The patient in general 1 0 0
74   Language problems 0 1 0
75   Preferences 0 0 1
  No barriers perceived   5 (7.2) 3 (5.6) 1 (2.9)
  Total   69 (100) 54 (100) 35 (100)