Key PointsQuestionWhat do surgical team members and administrators think and experience regarding modifications to the World Health Organization's Surgical Safety Checklist (SSC) in high-income hospital settings?FindingsIn this qualitative of study including 51 participants, 5 themes emerged: awareness and involvement in modifications; reasons, types, and outcomes of modifications; and perceived barriers. Interviews revealed SSCs may go unrevised for many years and face obstacles like leadership and computer system integration, but modifications address local issues, ensure purposefulness, reduce adverse event risk, and foster ownership and participation among health care professionals.MeaningThese findings suggest that modifying SSCs may enhance patient safety and team cohesion while offering opportunities for increasing team members’ involvement and buy-in.