1. CRM and Checklists Robert S. Barrett SureSurgery Inc. GreenDot Global Inc.

3. CRM Refresher Management philosophy Management philosophy Focus not on technical skills but interpersonal, leadership, and team Focus not on technical skills but interpersonal, leadership, and team Use all available resources for the best decision possible Use all available resources for the best decision possible Open communication and inclusiveness to improve situational awareness Open communication and inclusiveness to improve situational awareness Reminder of human fallibility (fatigue) Reminder of human fallibility (fatigue)

4. Preliminary findings in observing neurosurgical OR Little or no formal ‘briefing/debriefing’ Little or no formal ‘briefing/debriefing’ Little ‘overt’ redundancy checking Little ‘overt’ redundancy checking Several misunderstood/unacknowledged communications Several misunderstood/unacknowledged communications Extraneous conversation during ‘critical phases’ Extraneous conversation during ‘critical phases’ Little preparedness for mechanical equipment failures Little preparedness for mechanical equipment failures ‘Broken Window Effect’ was present (once lax procedures start they tend to form the new norm) ‘Broken Window Effect’ was present (once lax procedures start they tend to form the new norm) Some tension regarding “power” within team unit Some tension regarding “power” within team unit Lack of ‘handover’ procedures for shift changes Lack of ‘handover’ procedures for shift changes (Louw, D; Barrett, R..; Brien, S.; Kopp, G.)

5. Briefings and Checklists BRIEFINGS Reduce potential error and omission Reduce potential error and omission Set the tone Set the tone Communicate plan for any abnormal or emergency situation Communicate plan for any abnormal or emergency situation Pass routine information when necessary Pass routine information when necessary CHECKLISTS Reduce/trap potential error and omission Build redundancy Overcome interpersonal differences with SOP Establish procedural flow and norms

6. CRM and Briefing/Checklist Use IMPORTANT CONSIDERATIONS: Checklist types (flow; challenge-and-response; read-and-do; “I will – you will”) Checklist types (flow; challenge-and-response; read-and-do; “I will – you will”) Ease of use (functional fit into normal flows) Ease of use (functional fit into normal flows) Division of labour (who reads? who actions?) Division of labour (who reads? who actions?) Compliance and Standards (monitoring) Compliance and Standards (monitoring) Pushback (threat to authority; group culture) Pushback (threat to authority; group culture) Feedback loops (system learning; reports) Feedback loops (system learning; reports)

7. General “CRM” Guidelines Where are we right now? Where are we going? What do we do if things go wrong? *situational awareness* *shared commitment* INTERPERSONAL AND TEAM PERFORMANCE Set the tone Set the tone Clarify receptiveness (input from team) Clarify receptiveness (input from team) Review roles and responsibilities for normal, abnormal, and emergency situations Review roles and responsibilities for normal, abnormal, and emergency situationsLOSA