Perception and Involvement of Operating Room Professionals in the Use of the Surgical Safety Checklist: A Cross-Sectional Study in Cameroon

Abstract

Background: The WHO Surgical Safety Checklist (SSC) is a simple, low-cost tool that has been shown to save lives in operating rooms around the world. Yet knowing about a checklist and actually using it well during a stressful surgery are two very different things. In Cameroon, as in many resource-limited settings, the gap between what teams know in theory and what they do in practice remains a real challenge. Methods: Between March and June 2025, we conducted a cross-sectional study in the operating theatres of two referral hospitals in Yaoundé. Forty-one surgical team members completed a structured questionnaire. In parallel, a trained observer silently watched 25 actual surgical procedures to document exactly how and how fully the checklist was being used in real time. Results: The great majority of participants (85%) could accurately describe the checklist, and every single one agreed that it improves patient safety. Yet nearly half (46%) found it burdensome, and almost three-quarters (73%) struggled to use it during emergencies. When we watched actual surgeries, the picture became clearer: roughly 60% of checklists were executed incompletely or only on paper. Adherence was best during the Sign-In phase (78%), dropped noticeably during Time-Out (52%), and fell furthest during Sign-Out (41%). Conclusion: Surgical teams in Yaoundé understand the value of the WHO checklist. What is missing is not awareness but consistent, meaningful practice. Closing this gap will require visible leadership from senior clinicians, hands-on team training especially for emergency scenarios and an effort to weave the checklist into the natural rhythm of daily surgical work rather than treating it as an added formality. Keywords: Cameroon; Operating Room; Patient Safety; Quality Improvement; Surgical Safety Checklist.