A Cross-Sectional Survey of the Adoption and Fidelity of the WHO Surgical Safety Checklist in Central Region District Hospitals, Ghana

The World Health Organisation (WHO) Surgical Safety Checklist is a standard tool for reducing perioperative complications. Its effective implementation in low-resource district hospitals is essential yet often problematic. This study assessed the adoption and fidelity of use of the WHO Surgical Safety Checklist in operating theatres of district hospitals within Ghana’s Central Region. A cross-sectional survey was conducted using a structured questionnaire administered to theatre staff—including surgeons, anaesthetists, and nurses—in all surgically capable district hospitals in the Central Region. Data were collected on the checklist’s availability, frequency of use, and completeness of its three phases (Sign In, Time Out, Sign Out). The checklist was physically present in 85% of the operating theatres surveyed. However, fidelity to the complete three-phase process was low. Only 32% of respondents reported consistent completion of all phases for every procedure. The ‘Sign Out’ phase was the most frequently omitted. Adoption of the checklist in terms of physical availability is high in Central Region district hospitals, but fidelity to its intended, consistent, and complete application is suboptimal. Targeted interventions, including regular training and supportive supervision, are required to improve complete checklist utilisation. Hospital management should monitor fidelity of use, not merely the checklist’s presence. Surgical safety checklist, patient safety, implementation fidelity, district hospitals, Ghana, operating theatre This study provides empirical evidence on the implementation gap of a key patient safety tool in a representative sample of district hospitals, highlighting a critical area for health systems strengthening in Ghana.