Stacy Kozak, Manager with the Alberta Health Services (AHS) Surgery Strategic Clinical Network (SSCN) will provide insight on the province-wide approach that has taken compliance with the AHS Safe Surgery Checklist from 50 to better than 90 per cent in two years. WATCH: http://goo.gl/AGde67

1. THE SAFE SURGERY CHECKLIST….
MORE THAN JUST A GOOD
CATCH
April 8, 2016

2. Welcome!
Gina Peck
Project Coordinator/Technical Host
Carla Williams
Patient Safety Improvement Lead

3.  Please enter any
questions in the Q and A
box
 Slides for today’s
presentation
 Today’s call will be recorded
Before we get started

4. Our Guest Speakers
Leslie Deuchar; a patient advisor on
the AHS Surgery Strategic Clinical
Network
Stacy Kozak ; the manager of the
Surgery Strategic Clinical Network
at Alberta Health Services.
Dr. Giuseppe Papia ; a member of the
Division of Cardiac and Vascular Surgery and
Critical Care Medicine at Sunnybrook HSC
and SSCL Intervention Lead at CPSI.

5. Safe Surgery 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

6. Safe Surgery 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.  No one can stop an idea whose
time has come
Voltaire

10.  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 - January 2011
Rapid dissemination of SSCL

11. SSCL

12. • 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.

13. Between the healthcare we
have and the healthcare we
could have lies not just a gap,
but a chasm.
Crossing the quality Chasm (IOM)

14. Les Deuchar, SCN
A Christmas Story
Les Deuchar,
Patient Advisor Surgery SCN
Core Committee

22. STRIKING GOLD: FINDING VALUE
IN THE SAFE SURGERY
CHECKLIST
Stacy Kozak, Surgery Strategic
Clinical Network Manager

27. THE CHECKLIST PARADOX
 The tool – a checklist – is simple
 The act – a briefing – is less simple
 And the social process of
implementing and sustaining briefing
practice is complex
The Checklist Manifesto Surgical Checklists,
System Change, Collective Competence and Complexity
Lorelei Lingard, PhD October 2013

28. Was the checklist used?
Were all team members paying
attention?
Did all team members feel able to
speak up?

29. Striking Gold!

30. Surgical Services in Alberta
• ~59 AHS Facilities
providing surgical care
• ~275,000 cases
completed in a Main OR
annually
• AHS is spending ~$900M
on surgery related
activities**
* Source: Priorities & Performance Main OR Surgical Activity by Facility 2013/2014 Report.
Includes cases completed in a Main OR which are not considered surgical procedures e.g. endoscopies and cystoscopies.
** Source: AHS Finance. Estimate does not include any physician costs, overhead allocations or hospital stays in Med/Surg units, any
surgical activity that takes place in non-OR clinics, surgery-related imaging or a host of related items.

31. What are Strategic Clinical Networks?
 Collaborative provincial clinical groups
– Hosted by Alberta Health Services
 Focused on stages of life, diseases/conditions, in order to:
– Improve patient outcomes and satisfaction
– Increase access and quality
– Build a health care system that is sustainable
2012: Addictions & Mental Health, Bone & Joint, Cancer, Cardiovascular Health & Stroke,
Diabetes Obesity & Nutrition, Seniors Health
2013: Critical Care, Emergency,
2014: Respiratory Health
2015: Maternal Newborn Child & Youth
2016: Kidney Health (January 8), Primary Health Care, Population, Public & Aboriginal
Health (March)

32. Alberta’s Journey
Transition to
Ops
2010 2011 2012 2013 2014
Sites self reporting
100% compliance
Audited compliance
47%
Compliance
93%
2009
SSC
piloted
Alberta SSC
approved
2015
Compliance
95%
SURGERY SCN
PROJECT

34. Alberta’s Journey
 SSC Working Group
 Zone Implementation Leads
 Measurement and Reporting
Strategy
 Process for alternate versions
 Level 1 Policy updated
 Research on Patients and
Providers
Transition to
Ops
2010 2011 2012 2013 20142009
SSC
piloted
Alberta SSC
approved
2015
 Focus groups completed
 Auditor training developed
 Engagement visits
 Tableau reporting
 Submission tracking
SURGERY SCN PROJECT

35. Patient Focus
 PaCER conducted patient focus groups &
interviews on behalf of SSCN
 Patient involvement is fundamental to
success of the SSC (Briefing phase) and to
patient satisfaction

36. Patient Focus
http://www.surgery101.org/podcast/safe-surgery-checklist-1-pre-op-briefing/

37.  2 ways
 On the chart of every patient
 + observational audits on a SAMPLE of cases
Measurement

38. Observational
Audits

39. Tableau Reports
https://tableau.albertahealthservices.ca/workbooks/SafeSurgeryChecklistSSCDashboard

40. Changes over time

41. Good Catches
Examples:
• Patient anaphylactic to Penicillin; given Clindamycin instead
• Consent indicated right inguinal hernia; patient confirmed left inguinal hernia in briefing
• Implants were missing
• Antibiotics were not given pre-op; delayed skin incision until antibiotic administered

42. Thanks! Contact:
Stacy.kozak@ahs.ca

43. Giuseppe Papia

44. The Checklist Paradox
Assumption:
The checklist can improve culture in the operating
room

46. “the most common cause of failure in leadership is
produced by treating adaptive challenges as if they
were technical problems.”
Ron Heifetz
46

47.  There is inconsistent evidence from observational
studies that Safe Surgery Checklist improve
mortality and other surgical outcomes
 Safe Surgery Checklists improve perceived
teamwork and communication in the operating
room

48. Ann Surg 2013

51. Next steps
cwilliams@cpsi-icsp.ca
Stacy.Kozak@albertahealthservices.ca