Barriers and Facilitators in Implementing the Safety Climate Thermometer
A New Tool for Surgical Teams
Esther Martine van der Linde ( University Medical Centre Utrecht)
Wilhelmina M.U. van Grevenstein ( University Medical Centre Utrecht)
Alex Burdorf (Erasmus MC)
J. Henk Coert ( University Medical Centre Utrecht)
Linda S.G.L. Wauben (TU Delft - Mechanical Engineering, Rotterdam University of Applied Sciences)
Connie M. Dekker-van Doorn (Rotterdam University of Applied Sciences, Erasmus MC)
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Abstract
Objective: To explore barriers and facilitators in implementing the Safety Climate Thermometer (SCT), a new tool designed to support team-level safety culture improvement in surgical settings. The SCT acts through visual insights into safety culture themes, acting as a conversation starter, and interdisciplinary team meetings about this topic. It aims to facilitate daily practice changes. The SCT has previously been developed using user-centered design methods, which consisted of a scoping literature review and international survey. Design: A qualitative implementation study using semi-structured interviews and observational data, guided by the implementation outcomes framework. Setting: Three surgical teams from Dutch hospitals of varying size participated between 2021 and 2023 and used the SCT's visual input and interdisciplinary team meeting structure for 7 months. Participants: Seventeen healthcare professionals, including nurses, surgeons, and managers, took part in the SCT process and subsequent interviews. Results: The SCT facilitated an anonymous, online assessment followed by structured interprofessional discussions and goal-setting for safety improvement. Participants reported high usability and acceptability due to the tool's intuitive design and anonymity. The SCT was adaptable to different surgical contexts, though smaller teams with motivated champions and in-person facilitation appeared most suitable. Key barriers included high turnover and work pressure, competing priorities, lack of trust, and survey fatigue. Facilitators include in-person external facilitation and “protected time.” Reported positive effects included strengthened team cohesion and a greater sense of being heard. Conclusions: The SCT is a practice-oriented, user-friendly tool for improving safety culture through team-based reflection and dialogue. Future use should prioritize exploration of contextual factors.
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