1. Webinar 10: Preparation for Expanding to Full Implementation

2. Summary of Last Week’s Call Importance of creating a checklist demonstration video. The Safe Surgery 2015: South Carolina Video Competition. Create a video using your hospital’s checklist and/or a video of a poorly done JC Timeout. Hospitals shared their experiences implementing the checklist. In particular: –Preparing surgical teams for testing the checklist. –Engaging skeptical colleagues in this process. –Completing the culture survey in your hospital. Strategies to use when administering the survey in paper form.

3. How Did the Homework Go?

4. Homework to Date – Slide 1 of 4 Gather an implementation team consisting of at least one administrator, anesthesia provider, nurse, and surgeon. Designate if your hospital will be participating in the research portion of this project. Schedule a time and venue for a meeting to take place in 8-10 weeks. Read background materials on the checklist and look at safesurgery2015.org website. Create a list using the excel template provided to you of all of the OR staff, physicians, and techs. This template asks for names, titles, and email addresses. If you are part of the research, please send us this spreadsheet. Send us a picture of your checklist implementation team.

5. Homework to Date – Slide 2 of 4 Start/Continue to administer the culture survey. Modify the checklist for your hospital and test it using “table top simulation” and with your checklist implementation team in 1 case for 1 day. Have the same team use the checklist in every case for one day. Modify as necessary and send us your checklist. Work with an additional surgical team to test the checklist in as many surgical cases as you can. Modify the checklist as necessary and send us a copy of your checklist. Use the Surgical Safety Checklist Observation Tool (Tool 4) in the cases that are testing the checklist.

6. Homework to Date – Slide 3 of 4 Members of the implementation team need to complete the web-based training for the teamwork observation tool (Tool 3). Identify departmental meetings to have the implementation team speak at following June 28th. Use the OR Personnel list 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. Identify possible skeptics and make a point to talk to them before you hold a large meeting, if possible. Think about ways to advertize the checklist in your hospital in preparation for the roll-out.

7. Homework to Date – Slide 4 of 4 Create a demonstration video using your hospital’s version of the South Carolina Surgical Safety Checklist. (All hospitals should do this). Finalize your hospital’s version of the checklist. Decide if the checklist will be used in poster or paper form in your ORs. If your hospital will be using posters, look into options to have them made. Optional Homework: If you want to be part of the video competition, create and send your hospital’s checklist demonstration video and/or video of a poorly done Joint Commission Time-Out to our team.

8. Today’s Topics Creating timelines and setting goals for your checklist implementation. Prioritizing surgical specialties for the roll- out. Displaying the checklist in the OR.

9. This Week’s Poll 1.How will you advertise the checklist in your hospital? 2.How are you planning on displaying the checklist in your OR?

10. Basic Planning Principles Arrange things in order of anticipated difficulty. Start with the surgeon or service that you think will be the most accepting. Use your OR Personnel Spreadsheet and rank the services. Create a timeline. Be flexible. Give enough time to do the work. It always takes longer than people initially think. Assign a member of the checklist implementation team to the area that will be using the checklist. They will be available to talk to surgical teams and trouble shoot any problems.

11. Small Hospitals < 4 ORs One room/surgeon each day. Talk to everybody on the surgical team before they use the checklist for the first time.

12. Example Timeline for Small Hospital DateServiceImplementation Team Member Assigned to talk to them SurgeonMembers of the Surgical Team Anticipate d Difficulty Monday, July 11 th GeneralSueDr. SmithRita, Mandy, and Dr. Jones. Easy Tuesday, July 12 th GeneralSueDr. BerryJoanne, Rick, and Dr. Foster Easy Wednesd ay, July 13 th GeneralKatieDr. JonesRita, Mandy, and Dr. Jones Moderate Thursday, July 14 th, OrthoDr. StraussDr. SminkJoanne, Rick, and Dr. Foster Difficult

13. Medium to Large Hospitals ~ one service per week. Talk to every member of the surgical team prior to when they use the checklist for the first time.

14. Service Line Roll-out Timeline WeekServiceDifficulty Week 1General SurgeryEasy Week 2Plastic SurgeryEasy Week 3Transplant SurgeryEasy Week 4Trauma SurgeryModerate Week 5UrologyModerate Week 6ENTDifficult Week 7Cardio-Thoracic SurgeryDifficult

15. Example of a given Week DateServiceImplementation Team Member Assigned to talk to them SurgeonMembers of the Surgical Team Anticipated Difficulty Monday, July 11 th GeneralMaryDr. MooreCN – Joan Anderson Scrub – Suzanne White CRNA – Chris Jones Easy Tuesday, July 12 th GeneralEricDr. BerryCN – Linda Johnson Scrub – Lisa Jackson Anesthesiologist – Paul Harris Easy Wednesday July 13 th GeneralEricDr. JonesCN – Rita Moore Scrub – Judy Allen CRNA – Debra Hughes Moderate Thursday, July 14 th GeneralDr. StraussDr. SminkCN – Joan Anderson Scrub – Ann Fisher Anesthesiologist – Randall Johnson Difficult

16. Collect Feedback Appoint a member of the implementation team to be the point of contact for individuals to talk to. If you are using a paper checklist have a space to write comments on the back. Set-up a short survey and ask people to complete it throughout the entire implementation process.

17. The System Needs to Accommodate Feedback If an individual raises an issues you need a system in place to fix it. –Increases buy-in. –Motivates individuals to use the checklist and give feedback.

18. Displaying the Checklist in the OR Small Scale Testing Paper Have circulator hold the checklist up in front of clinicians so they can read their parts aloud. Roll-Out Checklist Poster Electronic Medical Record Paper

19. This Week’s Homework Continue/Start to administer the culture survey. Continue to talk with your colleagues one-on-one. Hold the meeting that you scheduled at the beginning of the call-series with as many surgical personnel that can attend.

20. Materials for the Large Meeting We have created the following for you to use at your large meeting: –Presentation Template –Presentation Template Guide and Tips All of these materials will be available on the Safe Surgery 2015 website later today.

21. Large Meeting Share a story to show them why we want them to do this. Share the data that shows that the checklist can do good things. Show them an example of a team doing the checklist. Tell them the plan to introduce it to the OR.

22. This Week’s Homework Continue/Start to administer the culture survey. Continue to talk with your colleagues one-on-one. Hold the meeting that you scheduled at the beginning of the call-series with as many surgical personnel that can attend. Start your checklist advertising campaign. Prioritize surgical specialties for the roll-out using your knowledge of which surgeons will be most receptive to the checklist. Create a timeline for your hospital’s expansion and send it to the Safesurgery 2015 team at safesurgery2015@hsph.harvard.edu. If necessary, hold departmental meetings in the service that you are rolling the checklist out in.

23. Announcements The date that the videos are due for the video competition has been moved back to August 15 th. The winner will be announced on our last call, August 30 th. Office hours is cancelled this Friday and July 8th. Next week there will NOT be a Tuesday webinar. We are making presentations specialized for individuals disciplines. These will be available by the end of next week. We need your help for the culture survey. Please encourage your colleagues to take the survey.

24. ? ? Questions

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

26. Office Hours: Cancelled This Week and Next Week

27. Next Week’s Call: Cancelled Happy 4 th of July!

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