1. Webinar 13: Implementation Barriers

2. Summary of Last Week’s Call Making the debriefing count: The McLeod Experience Tips on engaging your colleagues when you talk about the checklist at departmental meetings or in large inter disciplinary meetings. SCHA Hospital Visits: The Best of South Carolina.

3. How Did the Homework Go?

4. Homework to Date Slide 1 of 4 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.

5. Homework to Date Slide 2 of 4 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. Identify people that you think will be skeptical of using the checklist and try to talk to them before you hold a large meeting.

6. Homework to Date Slide 3 of 4 Organize and conduct one-on-one conversations. Create a checklist demonstration video for your hospital. Decide if the checklist will be used in paper or poster form. Finalize your hospital’s checklist, please send it to us so we can see how you made the checklist work for you. Start your checklist advertizing 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.

7. Homework to Date Slide 4 of 4 Mark your calendars for the April Patient Safety Symposium (April 24 th – 26 th ). Hold departmental meetings in the service that you are putting the checklist into place next. Hold the large inter-disciplinary meeting that you scheduled at the beginning of the call series. If you are ready, start implementing the checklist over the next week with the service/surgeons that you think will be most receptive.

8. Poll 1: Do You Already Have a System In Place to Collect Feedback From Surgical Teams About Equipment Problems That Need To Be Addressed and Then Fix Them? Yes No We are actively working on putting one into place.

9. Poll 2: Who Is Using the Checklist at Your Hospital? The team that is helping us modify the checklist is the only team using it. We have expanded the checklist to additional teams, but it is not used by the majority of the teams. Less than 50%. The majority of our surgical teams are using the checklist. More than 50% Every surgical team is using the checklist.

10. Today’s Topics Continuation of last week’s discussion of engaging your colleagues at meetings. SCHA Hospital Visits: Opportunities for Improving Checklist Use. Case Studies.

11. Continuation of Engaging Your Colleagues in Meetings

12. The “Scrub Sink Trance”

13. “Reverence for Induction”

14. “Respect for the Counts”

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

16. Barriers, Challenges, and Opportunities March 1, 2012

17. Site Visits Overview Visits to observe the checklist in action We’ve visited more than 30 hospitals and would like to visit each of you at least once Verbal debrief on the day of the visit with a formal report to follow to discuss the strengths and opportunities for improvement Feedback also goes to Harvard team to help us learn about you and shape Safe Surgery 2015: SC

18. Education Educate prior to and during implementation –Education months before implementation can cause fatigue if staff don’t get to test the checklist Limited understanding of the checklist/initiative Re-education is important to keep the staff interested and energized Focus is often on the time out Communication in silos vs. as a team

19. Lack of ownership / champions Staff participate in develop / modifications It is key to have a physician champion We need champions in each position

20. Assumptions about… Who really knows everyone in the room Staff’s comfort level with speaking up How the staff are actually using the checklist How well your teams are currently working together –Consider teamwork and checklist observation tools

21. Execution Checklist should not be completed from memory –Hard copy that everyone can read Review all checks in order – even if they don’t apply for a particular patient Concerns about pre-anesthesia checklist outside of the OR All portions of the checklist should be reviewed as a team Consider reviewing the South Carolina template

22. Most common concerns “Already doing this” “We area already safe/small - this doesn’t apply here” “This is going to take way too long!” “That check doesn’t concern anyone else” “Where’s the data?”

23. Be Cautious About Phrasing on the checklist How checklist audits are viewed Allowing team members to complete their checklist in silos

24. Contact Us Ashley Kay Childers childer@clemson.edu Kimberly Hubbard khubbard@scha.org

25. Take Homes About Site Visits

26. Case Studies 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”

27. Case 1: The Facts Harvard Hospital built an inter-disciplinary implementation team to customize and test the Surgical Safety Checklist. The team that tested the checklist was happy with the content and thought that it worked well in their operating rooms. The implementation team wanted to test the checklist with additional surgical teams to make sure that it worked before finalizing the checklist. Over the next two weeks they spread the checklist to other surgical teams and collected feedback. The feedback that they received was that the checklist was too long and that the physicians did not want to keep using it. What would you do?

29. Poll 1.What would you do if this happened to you?

32. This Week’s Homework Continue to: –Administer the culture survey. –Have one-on-one conversations with as many people as you can. –Hold departmental meetings. Mark your calendars to attend the 2012 April Patient Safety Symposium. If you have not already done so, hold the large inter- disciplinary meeting that you scheduled at the beginning of the call series. Continue to implement the checklist.

33. ? ? Questions

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

35. Office Hours: Next Tuesday from 2:00- 3:00

36. Next Call: Improving the Checklist Through Coaching in the OR March 8 th, 2012 2:00-3:00

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