1. Webinar 9: Engaging Your Colleagues Continued

2. Mark Your Calendars For The Patient Safety Symposium Columbia, South Carolina April 24 th – OR Team Training, This session offered at no cost to you. April 25 th – Atul Gawande will be giving a keynote speech and we will be holding a breakout session. Contact Mary Stargel For More Information: mstargel@scha.org

3. Summary of Last Week’s Topics Methods of engaging your colleagues. The importance of one-on-one conversations. Demonstrations of what this conversation might sound like. More details on the South Carolina Video Competition. April Patient Safety Symposium.

4. How Did the Homework Go?

5. Homework to Date Slide 1 of 3 Build an implementation team. Schedule a time and venue for a meeting to take place after January. Download the OR Personnel Spreadsheet from our website and begin completing the information with the names, roles, and email addresses if relevant. Review the checklist modification guide and South Carolina Checklist Template. Modify the checklist with your implementation team and use it in a “table-top simulation”. Test the checklist with one team and modify if necessary.

6. Homework to Date Slide 2 of 3 Email us a picture of your checklist implementation team. Identify departmental meetings to have the implementation team speak after call 10. Expand the testing of the checklist to one team using the checklist for every case for one day. Modify the checklist as necessary. Email us your hospital’s checklist. If you haven’t already done so, please call or email our team about whether you would like to administer the culture survey. Email everything to safesurgery2015@hsph.harvard.edu

7. Homework to Date Slide 3 of 3 Identify people that you think will be skeptical of using the checklist. If possible we would like for you to start organizing yourselves for the one-on-one conversations.

8. Poll 1: Are You Planning on Conducting One-on-One Conversations? Yes No We are still thinking about it

9. Poll 2: If You Answered Yes, Who Are You Planning on Having One-on-One Conversations With? (Please Check All That Apply) Everybody that works in the OR Surgeons Nurses Anesthesiologists/CRNAs The physicians that are skeptical

10. Poll 3: Do You Think That A Non-Physician Could Have This Discussion With Physicians? Yes No It depends on if the they are respected by the physician.

11. Poll 4: Who Is The Best Person To Have This Conversation? (Please Check All That Apply) One of their peers A physician that is a member of the same practice group The chief of their service Anybody that they respect

12. Today’s Topics Identifying the people that might not want to use the checklist and strategies to use when you talk to them. A hospital’s story of working with a skeptical surgeon. Organizing your implementation team to conduct one-on-one conversations. Presenting this work to surgeons. I will give a demo presentation specifically targeted towards surgeons.

13. Physician Engagement Observed During a Surgical Checklist Implementation

16. Having a One-on-One Conversations Helps Don’t try to “fix” them with the checklist. Have a person that they respect talk with them in a one-on-one conversation before you hold large or discipline specific meetings about the checklist. Don’t force them to use the checklist initially. Ask them to not obstruct everybody else from using the checklist.

17. Scott Parker, MD Baptist Easley Hospital

18. Organizing Your Team to Conduct One-On-One Conversations

19. The Importance of the OR Personnel Sheet

20. Multiplying Yourself: How to Talk to a lot of People

21. A Presentation for Surgeons

22. The Case 45 year old with breast cancer. Elective mastectomy. Patient wants immediate reconstruction by plastic surgeon. General surgeon does mastectomy. Preference card is lost so instrument set not standard. Very small room. Scrub tech leaves because of family emergency. Circulator becomes scrub nurse.

23. More Facts Circulating nurse is now covering two OR’s. Plastic surgeon comes into room “early”. Wants to begin reconstruction before general surgeons is finished. Plastic surgeon “disruptive” saying procedure going “too slow”. General surgeon insists on completing mastectomies first.

24. What Happened Here The breast specimen was lost. Surgeons had never worked together before and did not talk before procedure. No “plan” for how surgery was to take place. Nursing staff very stressed by surgeons and level of workload. Complete system breakdown in processing specimens.

25. Don’t We Already Do All of This? It is more than the time out and our usual safety checks. This is our chance to build on the time out and make it contribute significantly to every case. Encouraging a conversation at the beginning and end of surgery to improve communication. Providing structure and consistency so that every patient gets what they need every time.

26. We are very good at what we do…. We can be even BETTER

27. Makary et al., J Am Coll Surg 2006; 202: 746-52 We Are Not as Good as We Think

28. How Can the Checklist Help Us Be Better? It makes sure that we do the things that our surgical patients need every time. It improves communication, teamwork and the culture of safety in our hospital. Can make surgical teams more efficient – It has been known to save time.

29. Physician Acceptance is the Critical Factor in Successful and Meaningful Use of the Checklist

30. HOW YOU ACT DURING THE TIME OUT/CHECKLIST MATTERS The team is looking to you for leadership. You are setting the tone for the rest of the operation. Others will follow your patterns of communication. This is an opportunity to make your plan clear, answer questions, demonstrate openness and professionalism.

31. How Do We Feel in the OR Stressed Focused “It’s time to do the CHECKLIST” I don’t want to do it – I never did this before – it makes me feel weird I am already safe - I don’t need to do it Maybe the surgeon in the next room needs it

32. The “Scrub Sink Trance”

33. SURGEONS CAN MAKE A DIFFERENCE It is our responsibility to work to improve the safety and outcomes of our patients. We are not powerless to make change. We are part of a surgical team and often in the position of leading that team – that is a privilege and an opportunity to make a difference.

34. What Can You Do? Activate people by using their names. Set the Tone – Make everyone feel “safe”. Tell the team what you are going to do. Encourage team members to speak up. Stop to Debrief at the end of the case.

35. This isn’t just about one person and what they need. Everyone is in the room for the patient and all of the people around you need your help, encouragement and leadership. Surgery is a team effort and the most effective and safe surgeons recognize that.

36. Safety is staying back from the Edge The Checklist can help you do that.

37. This Week’s Homework If you haven’t already done so, send us an email letting us know if you will be administering the culture survey. If you have started to administer the culture survey, please continue to do so. Use the OR Personnel Spreadsheet that you created for the administration of the culture survey and assign members of the implementation team to talk to everybody individually over the next couple of weeks. If possible, hold one-on-one conversations with the people that you identified as possible skeptics before you hold a large meeting talking about the checklist. Mark your calendars to attend the 2012 April Patient Safety Symposium.

38. ? ? Questions

39. Ask Us a Question By Using the Raise Hand Button

40. Office Hours: Cancelled Next Week

41. Next Call: Thursday, February 9 th Next week’s call is cancelled

42. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu