1. Webinar 12: Implementing the Checklist at Your Hospital Continued

2. Topics of Last Week’s Call State level overview of the culture survey results. A presentation for surgeons. Preparing your colleagues for using the checklist in the OR – A couple of reminders. –Show them how to use it. –Have them practice with it. –If someone really objects to using the checklist don’t make them do it.

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. 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 Safe Surgery 2015 team at safesurgery2015@hsph.harvard.edu. Start implementing the checklist with the service that you think will be most willing to use the checklist.

5. Today’s Topics A case study. Participants will share their experiences using the checklist and talk about where they are in terms of implementing the checklist. SCHA Hospital Site Visits. Most common issues/barriers seen with checklist use today.

6. A Case Study I need your help. You are experts in implementing checklists in the OR. We are going to practice giving advice by “solving problems” “Hospitals helping Hospitals”

7. The Facts A heart surgeon, an enthusiastic supporter of checklists, decided to try out a checklist he had been working on to use in heart surgery. While it was based on the South Carolina Surgical Safety Checklist, it had been thoroughly modified to meet the special needs of heart surgery. He had assembled a group to modify the checklist that consisted of an anesthesiologist, cardiac surgery nurse, another heart surgeon and a perfusionist who runs the heart lung machine. Everyone who worked on the checklist was very enthusiastic. They group did a table top simulation in the conference room where they met about once a month while working on their checklist.

8. The surgeon decided to try out his checklist during a relatively straight forward heart operation on a 70 year old man who needed a bypass operation. None of the members of the team that had helped to modify the checklist were in the operating room that day. The nurse, anesthesiologist and perfusionist, who were well acquainted with the Joint Commission time out, had never seen the checklist before they used it that morning. Because the surgeon wanted to be able to show that the checklist didn’t take too long, each portion of the checklist was timed that morning. No one had practiced using the checklist before they used it. The case went well. A survey was given to all of the surgical team members at the end of the procedure asking them their opinions about how the checklist had gone. To the surgeon’s surprise, no one on the operating team was enthusiastic about using the checklist again. In fact, most of the team felt that the checklist was useless and if they were to have surgery, definitely wouldn’t want a checklist used for them. They never wanted to use the checklist again.

9. Poll 1. If you could give the surgeon just one piece of advice, what would it be? 2.In getting ready to use the checklist for the first time in the operating room who should be in the operating room? 3.In getting ready to use the checklist for the first time in the operating room, how should people on the operating room team be prepared?

10. Where Are You? Hospitals Sharing Where They Are

11. Monica Barrington Georgetown Hospital System

12. Linda Starkey Lexington Hospital

13. SCHA Hospital Visits A team from the SCHA has been visiting hospitals to better understand checklist use. They observe how the checklist is used in the OR and talk to surgical team members and hospital leadership about using the checklist and the Safe Surgery 2015: South Carolina Project. Provide hospitals with on the ground support and feedback.

14. The Team Kimberly Hubbard, MHA Project Coordinator SCHA Ashley Kay Childers, PhD Systems Engineer SCHA Clemson University

15. Barriers and Opportunities Understanding of the checklist/initiative –Limited understanding of Safe Surgery 2015: SC –Teams that have been using the checklist since the Sprint may need reenergizing! –Focus is often on the time out –“Already doing this” or “Doesn’t apply here” –Communication in silos vs. as a team –“This is going to take way too long!” –Focus on the purpose!

16. Barriers and Opportunities (cont’d) Lack of ownership/champions –We need champions at each position! –Promote Safe Surgery 2015: SC education –Staff participation in development/modifications –Everyone “needs to know” –The checklist can be used for quality improvement!

17. Barriers and Opportunities (cont’d) Assumptions about… –How your staff are using the checklist –Checklist coming from memory –Pre-anesthesia portion of the checklist –How well your teams are currently working –Who knows everyone in the room –Staffs’ comfort level with speaking up

18. The Results From the First Question in the Poll If you could give the surgeon just one piece of advice, what would it be?

19. Announcements The webinar on Tuesday, August 9 th will be cancelled. Office hours on Friday, August 12 th will be cancelled.

20. ? ? Questions

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

22. Office Hours: Friday 12:00-1:00

23. Next Week’s Call: Implementation of the Checklist Continued

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