What People are Saying Across the Country: Qualitative Interview Results on Surgical Safety Checklist Implementation Cari Egan − Safer Healthcare Now!

Background Study Findings Where do we go from here? Highlights

Up to 70% of in-hospital adverse events occur during the peri- operative period, yet up to 50% are preventable. 1,2 The Surgical Safety Checklist (SSC) has been shown to reduce mortality and morbidity among surgical patients and promote teamwork and communication between the surgical team. 3 Improved patient outcomes have been connected to communication, team functioning, and culture change in the operating room. 4,5 Background

Methods Qualitative Descriptive Quality Improvement Project Convenience and Snowball Sample 11 semi-structured Interviews conducted (10 one-on-one, 1 focus group) with key stakeholders 6 OR Nurses [2 Educators, 1 Clinical Specialist, 3 Managers] 2 Anesthetists 3 Surgeons 1 Human Factors Specialist 1 Quality & Performance Improvement Coordinator

Findings Measure for compliance and not much else If you audit [a] group who says that they are doing [t he SSC] 97%... the same group is reporting 40‐70% antibiotics are given at the appropriate time bef ore surgery. It should be a force function…they s houldn’t start [surgery] until they have given anti biotics. Anesthetist If I had to rate my colleagues [checklist] interest and knowledge and practice I would give them a ‘D’. The checklist is not taken seriously. Anesthetist

Findings Key Themes 1.Haphazard “roll out” of the Surgical Safety Checklist 2.Interdisciplinary team communication: Far from embedded in operating room culture 3.Inter-professional communication in the operating room is impacted by the time pressures and divergent workflow patterns

Haphazard “Roll out” of the Surgical Safety Checklist “The checklist in [large healthcare centre] was not rolled out well at all. [Someone with experience with the SSC] came and gave a talk, but there wasn’t a big explanation of what was going to be expected during this process. Most people found out about the checklist during their business meetings, we were just told that we were supposed to start using a checklist…We were told very little. There was no discussion or presentations…not even during rounds. So it is not surprising that people just came up with road blocks on why they couldn’t use it. It was just rolled out from the top down.” Surgeon

Haphazard “Roll out” of the Surgical Safety Checklist Facilitators Buy In Physician Champions Education Pilot Testing Barriers Disengagement with Administration Stubborn Pride Inefficient Use of Operating Room Time Lack of Reward

Interdisciplinary Team Communication: Far from Embedded in Operating Room Culture “[…]in some circumstances it [checklist] actually causes conflict which is, I mean in any OR there is this ongoing power struggle between anesthetists and the surgeons, you have very hierarchical this top down going on, you’ve got the surgeons ruling the show and the anesthetists and surgeons power struggle always going on there. None of that is particularly good in terms of focusing on the case, and that is essentially what the checklist is supposed to do”. Anesthetist

“Nurses would like surgeons actually present. Surgeons are often not present for parts of the checklist, either the briefing or debriefing”. OR Nurse Manager Inter-professional communication in the OR Impacted by Time Pressures and Divergent Workflow Patterns

Regular audits (monthly) Consolidate patient assessments by nursing, anesthetics and surgeons by doing briefing Celebrate investment and participation in the checklis Teamwork and Communication Where do we go from here?

Thank you to all of the participants in this project Thank you to my colleagues on the SHN! Surgical Safety Checklist Metric Planning Group: Marlies van Dijk, Western Node Leader Safer Healthcare Now! Tanis Rollefstad, Western Node SIA Safer Healthcare Now! Leanne Couves, Improvement Associates Ltd. Virginia Flintoft, Project Manager Central Measurement Team, SHN! Ioana Popescu, Surgical Safety Checklist Project Manager, CPSI