A Primer For Providing Highly Reliable Care Bill Berry, MD, MPH

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Safe Surgery: South Carolina Program Engagement: Leadership Team and Hospitals Hospital Checklist Implementation: Three Waves of Education Series Building a Stronger Healthcare System: Hospital Site Visits, OR Team Training, and In-Person Meetings Measurement: Monitoring the impact of the checklist at a state level and in individual hospitals

South Carolina Program Activities Hospitals that participated in the webinar educational series 52 Number of clinicians trained over 6 OR Team Training Sessions 223 Number of clinicians trained over 6 in-person meetings 392 Hospital visits by Safe Surgery 2015 team 131 56 unique facilities

63 Safe Surgery Participating Hospitals Pelham Medical Center Piedmont Medical Center Providence Hospital Providence Hospital Northeast Ralph Johnson VAMC Regional Medical Center Roper Hospital Roper St. Francis Mount Pleasant Hospital Self Regional Healthcare Shriners Hospitals for Children Spartanburg Medical Center Springs Memorial Hospital St. Francis Downtown St. Francis Eastside Summerville Medical Center Tidelands GMH Tidelands WCH Trident Medical Center Union Medical Center Williamsburg Regional Hospital Wm. Jennings Bryan Dorn VAMC Abbeville Area Medical Center Aiken Regional Medical Centers Anmed Health Medical Center Baptist Easley Hospital Beaufort Memorial Hospital Bon Secours St. Francis Hospital Cannon Memorial Hospital Carolina Pines Regional Medical Center Carolinas Hospital System - Florence Carolinas Hospital System - Marion Chester Regional Medical Center Clarendon Memorial Hospital Coastal Carolina Hospital Colleton Medical Center Conway Medical Center East Cooper Medical Center Edgefield County Hospital GHS Laurens County Memorial Hospital GHS Oconee Memorial Hospital Grand Strand Medical Center Greenville Memorial Hospital Greer Memorial Hospital Hampton Regional Medical Center Hillcrest Memorial Hospital Hilton Head Hospital KershawHealth Lake City Community Hospital Lexington Medical Center Mary Black Health System: Gaffney Mary Black Health System: Spartanburg McLeod Loris McLeod Medical Center Dillon McLeod Regional Medical Center McLeod Seacoast Hospital Medical University of South Carolina Moncrief Army Community Hospital Newberry County Memorial Hospital Palmetto Health Baptist Palmetto Health Baptist Parkridge Palmetto Health Richland Palmetto Health Toumey Patewood Memorial Hospital Chesterfield hasn’t done anything Marlboro Park Closed

Program’s Impact Across The United States 1200+ Healthcare Facilities Across The United States

Each Participating Hospital Has A Better Process Than When We Started…Even If They Aren’t Using The Checklist Perfectly

Post Surgical Mortality

107 lives saved

We have been working together since 2010… Why Are We Still Talking About Safe Surgery?

This Is A Journey That Takes Time Talk about providers wearing gloves….how long it took

15 SCHA Quality Improvement Initiatives Birth Outcomes Initiative Care Transitions Cardiac Arrest Registry to Enhance Survival (CARES) CDC HAI Reduction CLABSI CAUTI Initiative Hospital Engagement Network (HEN) 2.0 Just Culture Certification for SC Hospitals Newborn Screening Initiative & Regional Training Workshops Heart & Stroke Care Alliance Safe Care Safe Surgery Surgical Quality Collaborative Safety Program For Ambulatory Surgery Transforming Health Symposium Zero Harm Awards You are Becoming A Highly Reliable Organization Disappear – You are becoming a highly reliable organization

“A high reliability organization (HRO) is an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity”

Steps Hospitals Need to Take To Become Highly Reliable Organizations Leadership needs to be committed to zero harm A fully functional culture of safety needs to exist at all levels of the organization: Workers recognize and report issues and unsafe conditions The organization makes workers feel comfortable reporting issues The organization acts on what is reported in a timely manner The changes/improvements are communicated to workers Changes/Improvements are implemented using proven methods Lean, Six Sigma, PDSA, etc Chassin MR, Loeb JM. High-Reliability Health Care: Getting There from Here. Milbank Q. 2013;91(3):459–90.

High Reliability Organizations The Surgical Safety Checklist Need a “Just culture” Levels the hierarchy and improves culture in the OR Are committed leadership to zero harm A first step towards reducing harm to zero in the OR Have a pre-occupation with failure…forsee potential issues and fix them Through briefing and debriefing it attempts to prepare and prevent failure Require ongoing monitoring Requires to “never stop looking”

Safe Surgery Hospital Designation Hospitals self-certify that the checklist is used for every patient that undergoes surgery 18 hospitals have certified to date Next round of designations will be announced at the 2017 TAP Meeting. The application deadline will be announced the summer 2017.

New Safe Surgery Hospitals Hilton Head Hospital Mary Black Health System: Spartanburg

The Next Stop On The Checklist Journey & The Journey To Becoming Highly Reliable: New Webinar Series September 29, 2016 Celebrate where your hospital is…it has been hard work Know that the checklist work has been the beginning of becoming a highly reliable organization Understand how teams are using the checklist Pick a part of the process to improve Learn how to make meaningful improvement and keep the work going

We Need Your Help Check-in with your hospital’s checklist implementation team and see how the work is going Encourage your checklist implementation team to: Watch how the checklist is used in the operating room and to keep meeting as a team Attend the new checklist webinar series, September 29, 2016 Apply for the Safe Surgery Designation next summer… if your hospital uses the checklist for every patient

Thank You For More Information: www.safesurgery2015.org