Preparation for Expanding The Checklist: Lessons Learned from SC Hospitals

What We Covered & What We Asked For You To Do

• Prepare for having conversations with less enthusiastic team members.

• Organize your implementation team to conduct one-on-one conversations with everyone.

• Leverage staff and physician meetings to educate surgical team members about this initiative.

Meeting the Team

Jim SachettaProject Assistant

Harvard School of Public Health

Poll 1: Have You Started To Have One-on-One Conversations?

• Yes• No, but we are planning to start• No, we will not be having these

conversations

Today’s Topics• Advertising the project

– Overview of ways to advertise this program– Two experiences from South Carolina Ambulatory Surgery

Centers– Setting up a system to advertise “catches/saves”

• Applying the lessons from when you tested the checklist– Training Surgical Team Members– Having one-on-one conversations– Collecting Feedback

• Making Sure Your Checklist Is Ready: A few reminders• Creating a plan for spread

Advertising the Checklist

Advertising the Checklist in your Hospital

• Posters• Bulletin Boards• Emails• Hospital Newsletters• Buttons• Competitions• Videos

Remember: Advertising and Speaking at Staff Meetings Don’t Replace

The One-On-One Conversation

Stephanie Ziesing

Teresa DevoreAnmed Health, Medicus Surgery Center

Advertising Near Misses/Saves

• Post them on a bulletin board.• If you have a hospital newsletter write

about how the checklist has helped.• Share saves and other success stories in

meetings or huddles.

Planning The Roll-Out

Reflect on What Worked When You Tested the

Checklist• Arrange things in order of anticipated difficulty. Start with the

surgeon or service that you think will be the most accepting.• Create a timeline.• Be flexible. • Give enough time to do the work. It always takes longer than

people initially think.• Remember to engage everyone with a one-on-one

conversation.• Assign a member of the checklist implementation team to the

area that will be using the checklist. They will be available to talk to surgical teams and trouble shoot any problems.

Things to Remember When Training

• Explain the rationale of each checklist item.

• Educate team members about the state-wide Safe Surgery 2015 initiative.

• Practice running through the checklist with them before the team uses it with a patient.

• Have a member of the implementation team in the OR when the team is using the checklist for the first time.

Use A Video To Help Train Teams

• A picture is worth a thousand words.• You can show people how the checklist

should by showing them.• While it is helpful it cannot be the only

method of teaching people how to use the checklist.

Video Guidelines• Do not film video over a live patient.

• Use an empty OR, conference room, or simulator.

• Shoot the video with a portable camera, phone, or anything that you have available.

Keep Asking How It Is Going• Appoint a member of the implementation

team to be the point of contact for individuals to talk to.

• If you are using a paper checklist have a space to write comments on the back.

• Set-up a short survey and ask people to complete it throughout the entire implementation process.

Make Sure Your Checklist Is Ready: A Few Reminders

Displaying the Checklist• Make sure every member of the surgical

team can read a hard copy of the checklist.

• Make sure that every item on your checklist is in clear language.

• A larger checklist displayed in the OR signifies the importance of using it.

Use Your OR Personnel Spreadsheet To Plan Your

Roll-out

Small Hospitals< 4 ORs

• One room/surgeon each day.• Talk to everybody on the surgical team

before they use the checklist for the first time.

Example Timeline for Small Hospital

Date Service Implementation Team Member

Assigned to talk to them

Surgeon Members of the Surgical

Team

Anticipated Difficulty

Monday, July 11th

General Sue Dr. Smith Rita, Mandy, and Dr. Jones.

Easy

Tuesday, July 12th

General Sue Dr. Berry Joanne, Rick, and Dr. Foster

Easy

Wednesday, July

13th

General Katie Dr. Jones Rita, Mandy, and Dr. Jones

Moderate

Thursday, July 14th,

Ortho Dr. Strauss Dr. Smink Joanne, Rick, and Dr. Foster

Difficult

Medium to Large Hospitals• ~ one service per week.• Talk to every member of the surgical team

prior to when they use the checklist for the first time.

Service Line Roll-out Timeline Week Service Difficulty

Week 1 General Surgery Easy

Week 2 Plastic Surgery Easy

Week 3 Transplant Surgery Easy

Week 4 Trauma Surgery Moderate

Week 5 Urology Moderate

Week 6 ENT Difficult

Week 7 Cardio-Thoracic Surgery Difficult

Example of a WeekDate Service Implementation

Team Member Assigned to talk to

them

Surgeon Members of the Surgical Team

Anticipated Difficulty

Monday, July 11th

General Mary Dr. Moore CN – Joan AndersonScrub – Suzanne White

CRNA – Chris Jones

Easy

Tuesday, July 12th

General Eric Dr. Berry CN – Linda JohnsonScrub – Lisa Jackson

Anesthesiologist – Paul Harris

Easy

WednesdayJuly 13th

General Eric Dr. Jones CN – Rita MooreScrub – Judy Allen

CRNA – Debra Hughes

Moderate

Thursday, July 14th

General Dr. Strauss Dr. Smink CN – Joan AndersonScrub – Ann Fisher

Anesthesiologist – Randall Johnson

Difficult

Where We Are Going• The next call we will discuss keeping the checklist

going in your hospital.• Physician webinar – April 11th 7:00-7:30• April 16th OR Team Training:

– Overview of team training, speaking up, closed loop communication, using the checklist as a teamwork tool.

• April 17th Patient Safety Symposium breakout focused on sustainability and next steps.

• Next phase of the webinar series will start May 2nd and we will discuss other ways of preventing SSIs and DVTs.

This Week’s Homework• Have one-on-one conversations with everyone that works in

your ORs.

• Create a plan for rolling out your checklist to all of your ORs.

• If you are ready, start expanding the use of the checklist to other teams.

• Mark your calendars for the following events:– Thursday April 11th, 7:00-7:30- Special Physician Webinar

– April 16th – OR Team Training Columbia, SC

– April 17th – Safe Surgery 2015 Breakout Session: Sustaining Checklist Use

?Questions

Ask Us a Question By Using the Raise Hand Button

Office Hours:

Next Wednesday at 2:00

Next Call:Thursday, April 4th

Keeping the Checklist Going

Resources

Website:www.safesurgery2015.org

Email: safesurgery2015@hsph.harvard.edu