1. Check-In Call

2. Welcome Back

3. Where Are You? 1.What is the percentage of cases that now use the South Carolina Checklist? –< 50% –> 50% –Every team uses the checklist for every case 2.What have you worked on since our last call? (Please check all that apply) –Modified the checklist –Trained surgical teams on how to use the checklist –Conducted one-on-one conversations with surgical team members –Observed how the checklist is used –Coached in the OR –Mandated that the checklist be used in every case

4. What Are The Barriers That You Have Faced Since the Last Call? Misuse of the checklist Surgical teams have a lack of interest in using the checklist Pushback Improvement Fatigue Problems with teams doing the debriefing consistently

5. Pushback “When or if should we mandate using the checklist”

6. Improvement Fatigue

7. Doing the Checklist “Right” In order for the Checklist to work well it has to be used “right”. Improving communication between all members of the OR team is critical to successful implementation. Virginia Mason, 2010 Annual Meeting of the American Society Anesthesiologists

8. Checklists for Special Needs Rapid Turnover & Cardiac Surgery

9. Special Needs for Short Cases

11. Before Skin Incision ASCMain OR

12. Before Patient Leaves the OR ASCMain OR

13. Special Needs for Cardiac Surgery

17. Coaching & Team Training

18. Listening Asking Questions Trying to improve people’s performance What is Coaching? A Quick Review

19. Telling Criticizing Instructing What Coaching Isn’t

20. Ask Questions “I noticed that... can you help me understand?” “I saw that you..... can you explain?” “I observed that you.... What could you have done differently?”

21. Who Makes a Good Coach? The best coaches are: –coachable –respected by their peers –Understand how to give feedback

22. Show Me/Teach Me Watch Me Give Me Feedback C O A C H I N G N G

23. Think About What you saw Who you are talking to –Talk to the team What is going on in the OR

24. Your Observation What you saw –Be specific and clear

25. OR Team Training OR Team Training Program Piloted in August. Trained six master trainers to teach the course in the future. We will be holding the next team training session in early February 2012 near the Charleston area. We are working on offering another training in April in Columbia as part of the Patient Safety Symposium. Implementation teams are encouraged to attend one of these trainings.

26. More Information on the OR Team Training Program Lorri Gibbons South Carolina Hospital Association lgibbons@scha.org

27. Eric Murdock Palmetto Health, Richland

28. How Do We Know When We Are Done? Have members of your surgical teams complete a document that we call, “Are we a Safe Surgery 2015 Hospital”. (Questions on the next two slides) Ask people from all disciplines to complete this form. If anybody answers “no” you are not done with this work.

29. Are We a Checklist Hospital? 1. Does your surgical checklist have three phases, before induction of anesthesia, before skin incision, and before the patient leaves the room? 2. Are the items on the checklist read aloud, without reliance on memory, so all members of the team can hear them? 3. Are all three phases of the checklist performed for every patient undergoing a surgical procedure in your hospital’s operating rooms? 4. Does every person that is present in the operating room say something before skin incision, at a minimum they introduce themselves by name and role or state that they are ready to proceed? (This includes perfusionists, surgical assistants, PAs, residents, observers, manufacturer representatives, and other observers)

30. Are We A Checklist Hospital Continued 5. Does the surgeon share an operative plan and discuss: anticipated blood loss, expected duration of the procedure, possible difficulties, and implants or special equipment needed for the case with the entire team before skin incision? 6. Do nurses and surgical techs discuss with the entire team their concerns about the patient? 7. Do the anesthesia providers discuss with the entire team the anesthetic plan and airway or other concerns? 8. Does the surgeon ask the entire team to speak up if they have any concerns during the case? 9. Before the patient leaves the OR do ALL members of the surgical team discuss equipment problems that need to be addressed, key concerns for recovery and management, and anything that could have been done better to make the case safer or more efficient?

31. ? ? Questions

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