1. Webinar 16: Are You Where You Want to Be?

2. Topics of Last Week’s Call OR Team Training Update Hospitals will share their experiences with implementing the checklist at their hospitals. Molly McBrayer, Bon Secours St. Francis Hospital, Charleston April Howell, McLeod Regional Medical Center Announcements

3. How Did the Homework Go?

4. Last Weeks Homework Continue/Start to administer the culture survey. Continue to talk with your colleagues one-on-one. If you haven’t already, hold the meeting that you scheduled at the beginning of the call-series with as many surgical personnel that can attend. This can be a large inter-disciplinary meeting or departmental meetings. 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 Safe Surgery 2015 team at safesurgery2015@hsph.harvard.edu. Continue implementing the checklist. Use the Surgical Safety Checklist and Teamwork Observation Tools together in five cases. If you are part of the research please send us the completed observations.

5. Today’s Topics Tips on: –Preventing problems –Fixing problems –What you can do now to enhance checklist use Looking into the future - What will it be like in three months? Assessing where your hospital is in terms of checklist implementation - Are you where you want to be?

7. Preventing Problems One-on-One conversations

8. Fixing Problems Coach surgical teams and individuals in the OR. If you identify a team or team member that is not using the checklist have an individual or a team conversation.

9. What Could This Conversation Look Like? Chief of Surgery learns that one of the surgeons refuses to use the checklist. He sends the surgeon that refuses to use the checklist an email asking him to come to his office. “I heard that you don’t want to use the checklist. Help me understand why?”

10. What Are Some Things You Can Do Now? Use the observation tools to see how team’s are using the checklist and coach them. Collect and post instances of when the checklist catches something. Consider having individual conversations with some front-line staff, including physicians and ask them how they think it is going.

11. A Look Into Three Months in the Future

12. A Hospital’s Story When they put the checklist into place they did a fantastic job: –Modified the checklist for their hospital –They spread it slowly –Measured the culture –One-on-One conversations took place –They performed observations in their ORs to see how people were using the checklist

13. A Hospital’s Story: 3 Months Post Roll-Out They stopped monitoring the checklist once they thought everybody was using it well. Front line staff reported that half of the time the teams do not read off of the checklist, instead they rely on memory. Trying to decide how to embed the checklist into their EMR. Re-giving the culture survey, six months after beginning the work.

14. What Do You Do When Things Aren’t Where You Want Them To Be Monitor how teams use the checklist with the observation tools. Coach surgical teams and individuals on how to improve their checklist performance. Consider re-giving the culture survey.

15. IF YOU ARE GOING TO USE THE EMR TO DOCUMENT THE CHECKLIST GUARD CAREFULLY AGAINST TURNING THE CHECKLIST INTO A “TICK THE BOX” EXERCISE

16. Are You Where You Want To Be?

17. Your Hospital’s Implementation Team 1.Do you have an implementation team that meets regularly? (This team should consist of at least one Anesthesiologist/CRNA, Administrator, Nurse, Scrub Tech, and Surgeon) –Yes –No –We have an implementation team, but we do not meet regularly. –We do not have an implementation team yet.

18. Checklist Modification 1.Did you modify the checklist for your hospital? –Yes –No –We are still in the process of modifying the checklist

19. Checklist Use 1.Has at least one surgical team tried using your customized version of the checklist? –Yes –No 2.Does at least one surgical team routinely use your customized version of the checklist? –Yes –No 3.If you answered yes to question 2, what is the percentage of surgical teams that are routinely using your customized checklist? –< 50% –> 50% –Every team is using the checklist

20. One-on-One Conversations 1.What percentage of your surgical staff have you or your colleagues had one-on- one conversations with? –0%, We have not had these conversations. –< 50% –> 50 % –We have had these conversations with all of our physicians.

21. Observing Teams Using the Checklist 1.Have you observed surgical teams in your hospital using the observation tools? –Yes –No

22. This Week’s Homework Continue to: –Implement the checklist –Administer the culture survey –Have one-on-one conversations with surgical team members

23. Announcements We want to highlight all of the teams that have done work to put the checklist into place in their hospitals at the TAP Conference in September. If you haven’t already done so, please send us a picture of your checklist implementation team. If you have strong “champions” that you would like to highlight, please send us their headshots. Email all of your pictures to: safesurgery2015@hsph.harvard.edu

24. ? ? Questions

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

26. Office Hours: Cancelled This Friday

27. Next Week’s Call: Atul Gawande Will Be Joining Us and We Will Talk About Keeping the Checklist Going and Next Steps in This Project

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