Introducing the Checklist 101: Hard Lessons Learned From Life. Bill Berry, MD, MPH Sunil Eappen, MD Lizzie Edmondson. Topics. Safe Surgery 2015: South Carolina Keys to introducing the checklist Monitoring the checklist at your hospital The call series
Bill Berry, MD, MPH
Sunil Eappen, MD
Safe Surgery 2015: South Carolina
Keys to introducing the checklist
Monitoring the checklist at your hospital
The call series
Your involvement in checklist implementation
By the end of 2013 every patient undergoing surgery in the state will have a modified version of the checklist used during their operation.
How many of you know the background of the WHO Surgical Safety Checklist?
How many of you are using a modified version of the checklist at your hospital?
How many of you tried using the checklist at your hospital, but weren’t able to get others to do it?
We asked your CEO to do the following:
Engage Executive Leadership
Gain the endorsement of the Hospital Board and Medical Executive Committee
Meet with clinical leadership to ensure that they are committed to working on this project
Identify individuals that will serve as the checklist implementation team in collaboration with clinical leadership
The nurses will know
Pick those who are respected and who will be supportive
The support of “formal” leadership is absolutely necessary but those leaders are often not the ones who should guide this effort directly
Only expand when you are ready
Do not tie yourself to a firm timeline – be flexible
Keep pressure on yourself to move forward but remember . . . .no preconceived plan ever survives contact with reality
Careful preparation is much easier than repairing the damage of moving too quickly
Modify the checklist (Tips on next slide)
Practice using the checklist outside of the OR and modify as needed
Use the modified checklist in one case with one enthusiastic team
Debrief and modify the checklist as needed
Use the checklist for one day in every case with the same team
Debrief and modify as necessary
Avoid adding too many items:
Each section should take < 1 minute
The checklist should never take longer than the procedure
To improve the performance of processes in the OR that every patient should have done
To improve communication and teamwork in the OR
“Will everyone please state name and role?”
"Confirm all team members have introduced themselves by name and role”
"We'll start by introducing ourselves and our roles”
"Team members introduced themselves by name and role"
"Confirm all team members have been introduced and actively participate"
Surgeon says: “If anyone on the team sees something that the team should know about, please speak up”
Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure
Surgeon states,“ Remember that all are free to voice any concerns at any time throughout the procedure”
Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?”
Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure”
Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”
Does the entire team stop all activity at the three critical points in care?
Does the team verbally confirm each item on the checklist?
Are the items verified without reliance on memory?
Does the checklist promote teamwork?
Avoid the temptation to take the easy way out
A checklist that becomes a tick box exercise is no checklist at all
Do not count on an “IT” system or electronic documentation to make this effort a success
In a “team”
Mass emails do not suffice
Talk to people
Do you have a good enough relationship to have this discussion?
Use a script to guide the discussion
Film it in an empty OR
Use someone's flipcam or camcorder
Many videos are available online, but one from your own place has the most impact
Exempla St. Meaningfully Accomplished By the Nursing Staff AloneJoseph Hospital
How NOT to Use the Checklist Video Meaningfully Accomplished By the Nursing Staff Alone
Same people can do observations
Trusted and respected
Best if known by most
Use this rule at the beginning and all the way through
Start with the “willing”
Don’t try to fix problem staff and clinicians
Share stories when you educate
Post the stories in a prominent shared space
An “IHI” story
You cannot spread the word too much
Support from the highest places is valuable
Support from respected clinicians is essential
Option 1: Meaningfully Accomplished By the Nursing Staff Alone
Monitoring the Checklist at Your Hospital
BRING YOUR OWN DATA TOGETHER AND ANALYZE IT YOURSELF
Use all or some of the tools to monitor your progress.
YOU WILL HELP US LEARN AND IMPROVE SURGICAL CARE WORLDWIDE
Use the tools to collect data and send it to HSPH
We analyze the data for you
We benchmark the data to other SC hospitals
No cost to you
Step by step instruction on checklist implementation from experienced faculty
Office hours to work through barriers with individual hospitals
Materials to assist with implementation
Discussion of measurement tools and use
Review of progress and opportunities to improve the implementation
Participate on the call series, even if your hospital uses the checklist
Coach individuals at your hospital on how to use the checklist
Track your hospital’s use of the checklist
Give us feedback
Return to your hospital and see what steps your CEO has taken
If needed help them build the checklist implementation team
Schedule a large meeting to educate as many surgical personnel as possible – anytime after June 28th