THE SURGICAL SAFETY CHECKLIST; RHETORIC….. OR ARE WE MAKING A DIFFERENCE? OCTOBER 8, 2014
Link to french and english
slides for today’s presentation
will be posted in the chat box
Today’s call will be taped ...
Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser
4
Be prepared to use: - Raise hand - CHAT
...
Discuss the role of communication and team work in patient safety
Review current data and state of the SSCL
Discuss a...
Our Guest Speakers:
Dr. Giuseppe Papia
Dr. Michael Leonard
Dr. David Urbach
Ms. Marlies van Dijk
Surgical Safety Checklist
Who Alliance for Patient Safety:
October 2004
Platform to promote Patient Safety Initiative...
Surgical Safety Checklist
Safe Surgery Saves Lives Campaign:
Improve safety of Surgery across the globe
Reduce the nu...
SSCL
No one can stop an idea whose time has come
-Voltaire
Between the healthcare we have and the healthcare we could have lies not just a gap, but a chasm.
Crossing the quality Ch...
The Role of Culture and Teamwork in Safe & Reliable Surgical Care
Michael Leonard, MD, Adjunct Professor of Medicine, Duk...
13
UNMINDFUL “We show up, don’t we?” Chronically Complacent
REACTIVE “Safety is important. We do a lot every time we hav...
Effective Leadership
Set a positive active tone
Think out loud to share the plan – common mental model
Continuously ...
Critical Behaviors
Culture and Leadership
•Ninety-two of the 101 study hospitals provided copies of their checklist; of these, 90% used an unmodified World Health O...
18
Teams
WHAT TEAMS DO:
Plan Forward
Reflect Back
Brief (huddle, pause, timeout, check-in)
Debrief
Communicate Clea...
19
•Over ½ of in hospital adverse events attributed to surgical care
•6313 checklist reviewed, >40% had a defect, total numb...
28
33
36
41
45
45
49
49
51
52
55
62
62
73
75
80
98
0
20
40
60
80
100
CCU
REHAB
OR
EMERG
5 WEST ...
28
33
36
41
45
45
49
49
51
52
55
62
62
73
75
80
98
0
20
40
60
80
100
CCU
REHAB
OR
EMERG
5 WEST ...
Wrong Site Surgery or Retained Foreign Body in 17 Operating Rooms
Operating Rooms
Debriefing – Linking teamwork and Improvement
What did we do well ?
What did we learn so we can do it better the next ...
REVIEW OF CURRENT DATA AND STATE OF SSCL
David R Urbach MD MSc
Professor of Surgery and Health Policy, Management and Ev...
Haynes et al NEJM January 2009
Mandatory reporting to Ontario Ministry of Health and Long-Term Care April 2010
Requir...
de Vries EN et al. NEJM 2010
de Vries EN et al. NEJM 2010
Mortality according to SSCL use
van Klei WA. Ann Surg 2012
Questions about the evidence
Checklist item “never events”
–e.g. wrong site surgery 10/1,000,000
No correlation with ...
Urbach DR. NEJM 2014
Urbach DR. NEJM 2014
Urbach DR. NEJM 2014
Ann Surg 2013
Summary
There is inconsistent evidence from observational studies that Surgical Safety Checklists improve mortality and ...
THE CHECKLIST PARADOX
[title stolen from Lorelei Lingard]
Marlies van Dijk
Director Clinical Improvement
mvandijk@bcps...
The RIGHT conversation?
Assumption:
The checklist can improve culture in the operating room
Makary, 2006 Journal of American College of Surgeons
“the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical prob...
Surgical Culture Change Strategy in BC
Situational Leadership
•Leader or manager of an organization must adjust their style to fit the development level of the ...
http://bcpsqc.ca/clinical-improvement/teamwork/resources/
Lorelei Lingard. Collective Competence. TED Talk http://www.youtube.com/watch?v=vI-hifp4u40
Rebecca Brooke. 3 page brie...
Interacting in WebEx: Today’s Tools Interagir dans Webex: outils à utiliser
56
Be prepared to use:
- Raise hand
- CHAT...
CONCLUSIONS:
Giuseppe Papia
Summarize the discussion of today’s call and post on website
 Loop back with the CPSI and possible steps forward and th...
c
Carla Williams cwilliams@cpsi-icsp.ca
Instructions to download certificate
1
2
3
4
5
6
7
8
9
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
The Surgical Safety Checklist; Rhetoric….or are we making a difference?
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The Surgical Safety Checklist; Rhetoric….or are we making a difference?

Purpose of the call: •Review current data and state of the SSCL •Discuss the role of communications and team work in patient safety •Discuss and define how we can measure the effectiveness of the SSCL. Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - The Surgical Safety Checklist; Rhetoric….or are we making a difference?

  • 1. THE SURGICAL SAFETY CHECKLIST; RHETORIC….. OR ARE WE MAKING A DIFFERENCE? OCTOBER 8, 2014
  • 2. Link to french and english slides for today’s presentation will be posted in the chat box Today’s call will be taped Certificate of attendance Before We Get Started
  • 3. Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser 4 Be prepared to use: - Raise hand - CHAT Have you used WebEx before? Avez-vous déjà utilisé WebEx? Soyez prêts à utiliser les outils : - lever la main - clavardage Type your message & click ‘send’ Select ‘send to’
  • 4. Discuss the role of communication and team work in patient safety Review current data and state of the SSCL Discuss and define how we can measure the effectiveness of the SSCL Followed by…..interactive discussion Objectives
  • 5. Our Guest Speakers: Dr. Giuseppe Papia Dr. Michael Leonard Dr. David Urbach Ms. Marlies van Dijk
  • 6. Surgical Safety Checklist Who Alliance for Patient Safety: October 2004 Platform to promote Patient Safety Initiatives Global Patient Safety Challenges  2005 Clean Care is Safer Care 2007 Safe Surgery Saves Lives
  • 7. Surgical Safety Checklist Safe Surgery Saves Lives Campaign: Improve safety of Surgery across the globe Reduce the number of surgical complications Reduce the number of surgical deaths
  • 8. SSCL No one can stop an idea whose time has come -Voltaire
  • 9. Between the healthcare we have and the healthcare we could have lies not just a gap, but a chasm. Crossing the quality Chasm (IOM)
  • 10. The Role of Culture and Teamwork in Safe & Reliable Surgical Care Michael Leonard, MD, Adjunct Professor of Medicine, Duke University Safe & Reliable Healthcare LLC
  • 11. 13 UNMINDFUL “We show up, don’t we?” Chronically Complacent REACTIVE “Safety is important. We do a lot every time we have an accident” SYSTEMATIC Systems being put into place to manage most hazards PROACTIVE “We methodically anticipate”— prevent problems before they occur GENERATIVE Organizational Culture “Genetically- wired” to produce safety Where is Yours? Safety Cultures Evolve Attribution: Prof. Patrick Hudson, Univ. Leiden
  • 12. Effective Leadership Set a positive active tone Think out loud to share the plan – common mental model Continuously invite people into the conversation for their expertise and concern Use their names
  • 13. Critical Behaviors
  • 14. Culture and Leadership
  • 15. •Ninety-two of the 101 study hospitals provided copies of their checklist; of these, 90% used an unmodified World Health Organization (WHO) or Canadian Patient Safety Institute checklist. Educational materials were made available to hospitals, but no team training or other support was provided. •The key is recognizing that changing practice is not a technical problem that can be solved by ticking off boxes on a checklist but a social problem of human behavior and interaction.
  • 16. 18 Teams WHAT TEAMS DO: Plan Forward Reflect Back Brief (huddle, pause, timeout, check-in) Debrief Communicate Clearly Structured Communication SBAR and Repeat-Back Manage Conflict Critical Language The Associated Behaviors:
  • 17. 19
  • 18. •Over ½ of in hospital adverse events attributed to surgical care •6313 checklist reviewed, >40% had a defect, total number of defects 6312 •Most problems pre- op or post-op, not in the OR
  • 19. 28 33 36 41 45 45 49 49 51 52 55 62 62 73 75 80 98 0 20 40 60 80 100 CCU REHAB OR EMERG 5 WEST 6 WEST PEDS GERI DIALYSIS PERIOP PHARM 3WEST ICU NICU SICU PEDS OB Teamwork Climate Scores Across Facility HCAHPS 92 50 Medication Errors per Month 2.0 6.1 Days between C Diff Infections 121 40 Days between Stage 3 Pressure Ulcers 52 18 Illustrative Data: Extracted from Blinded Client Data CULTURE IS RELATED TO…
  • 20. 28 33 36 41 45 45 49 49 51 52 55 62 62 73 75 80 98 0 20 40 60 80 100 CCU REHAB OR EMERG 5 WEST 6 WEST PEDS GERI DIALYSIS PERIOP PHARM 3WEST ICU NICU SICU PEDS OB Teamwork Climate Scores Across Facility Employee Satisfaction 91 55 Employee Injury per 1000 days 0.1 16 Employee Absenteeism per 1000 days 10 15 RN Vacancy Rate 1 9 <60% Score = Danger Zone Illustrative Data: Extracted from Blinded Client Data … AND UNFAVORABLE EMPLOYEE OUTCOMES
  • 21. Wrong Site Surgery or Retained Foreign Body in 17 Operating Rooms Operating Rooms
  • 22. Debriefing – Linking teamwork and Improvement What did we do well ? What did we learn so we can do it better the next time ? What got in the way that needs to be fixed ?
  • 23. REVIEW OF CURRENT DATA AND STATE OF SSCL David R Urbach MD MSc Professor of Surgery and Health Policy, Management and Evaluation, University of Toronto
  • 24. Haynes et al NEJM January 2009 Mandatory reporting to Ontario Ministry of Health and Long-Term Care April 2010 Required Organizational Practice for Accreditation Canada by January 2011 Rapid dissemination of SSCL
  • 25. de Vries EN et al. NEJM 2010
  • 26. de Vries EN et al. NEJM 2010
  • 27. Mortality according to SSCL use van Klei WA. Ann Surg 2012
  • 28. Questions about the evidence Checklist item “never events” –e.g. wrong site surgery 10/1,000,000 No correlation with improvement in processes Very effective (1.5%  0.8%) –Prevents 1 of every 2 deaths •Literature: 1/20 hospital deaths preventable –Prevents 1 death per 143 patients •Literature: 1/400 preventable hospital mortality
  • 29. Urbach DR. NEJM 2014
  • 30. Urbach DR. NEJM 2014
  • 31. Urbach DR. NEJM 2014
  • 32. Ann Surg 2013
  • 33. Summary There is inconsistent evidence from observational studies that Surgical Safety Checklists improve mortality and other surgical outcomes Surgical Safety Checklists improve perceived teamwork and communication in the operating room
  • 34. THE CHECKLIST PARADOX [title stolen from Lorelei Lingard] Marlies van Dijk Director Clinical Improvement mvandijk@bcpsqc.ca @tweetvandijk
  • 35. The RIGHT conversation?
  • 36. Assumption: The checklist can improve culture in the operating room
  • 37. Makary, 2006 Journal of American College of Surgeons
  • 38. “the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical problems.” Ron Heifetz 48
  • 39. Surgical Culture Change Strategy in BC
  • 40. Situational Leadership •Leader or manager of an organization must adjust their style to fit the development level of the followers they are trying to influence. •Up to the leader to change their style, not the follower to adapt to the leader’s style. •The style may change continually to meet the needs of others in the organization based on the situation. Developed by Kenneth Blanchard and Paul Hersey.
  • 41. http://bcpsqc.ca/clinical-improvement/teamwork/resources/
  • 42. Lorelei Lingard. Collective Competence. TED Talk http://www.youtube.com/watch?v=vI-hifp4u40 Rebecca Brooke. 3 page briefing note. Review of the Evidence for Culture Change: The Interpersonal Side of Healthcare. [scroll down page: http://bcpsqc.ca/clinical-improvement/teamwork/resources/ ] Makary MA et al. 2006. “Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder. http://www.sciencedirect.com/science/article/pii/S1072751506001177 Culture Change Tool Box. Rebecca Brooke. BC Patient Safety and Quality Council. http://bcpsqc.ca/clinical-improvement/teamwork/resources/ Checklist Paradox Presentation by Lorelei Lingard. SQAN November 2013. http://bcpsqc.ca/resources-from-sqans-2013-annual-meeting/ Ken Blanchard. Situational Leadership Technical Facilitator guide. http://www.kenblanchard.com/getattachment/Solutions/By-Offering/Government- Solutions/Situational-Leadership-II-(GSA-Approved)/SLII_Green_FG_Look.pdf Geert Hofstede’s Power Distance Index http://www.clearlycultural.com/ Ron Heifetz, Alexander Grashow and Marty Linsky. The Practice of Adaptive Leadership . Harvard Business Review Press. http://www.amazon.com/Practice-Adaptive-Leadership-Changing- Organization/dp/1422105768/ref=sr_1_1?ie=UTF8&qid=1411666918&sr=8- 1&keywords=the+practice+of+adaptive+leadership References
  • 43. Interacting in WebEx: Today’s Tools Interagir dans Webex: outils à utiliser 56 Be prepared to use: - Raise hand - CHAT Soyez prêts à utiliser les outils : - lever la main - clavardage Type your message & click ‘send’ Select ‘send to’
  • 44. CONCLUSIONS: Giuseppe Papia
  • 45. Summarize the discussion of today’s call and post on website  Loop back with the CPSI and possible steps forward and the role of the SSCL intiative in the Forward with Four priorities  Maintain an open dialogue with attendees Next steps
  • 46. c Carla Williams cwilliams@cpsi-icsp.ca
  • 47. Instructions to download certificate 1 2 3 4 5 6 7 8 9

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