The document discusses the effectiveness of the Surgical Safety Checklist (SSCL) in improving patient safety during surgeries, highlighting the role of communication and teamwork. It emphasizes that changing practices involves social behavior rather than merely technical solutions, and it presents mixed evidence regarding the impact of checklists on surgical outcomes. Key objectives include measuring SSCL effectiveness and fostering a culture of teamwork within surgical environments.

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

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5. 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

6. Our Guest Speakers:
Dr. Giuseppe Papia
Dr. Michael Leonard
Dr. David Urbach
Ms. Marlies van Dijk

7. 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

8. 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

9. SSCL
No one can stop an idea whose time has come
-Voltaire

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

12. The Role of Culture and Teamwork in Safe & Reliable Surgical Care
Michael Leonard, MD, Adjunct Professor of Medicine, Duke University
Safe & Reliable Healthcare LLC

13. 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

14. 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

15. Critical Behaviors

16. Culture and Leadership

17. •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.

18. 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:

19. 19

20. •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

21. 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…

22. 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

23. Wrong Site Surgery or Retained Foreign Body in 17 Operating Rooms
Operating Rooms

24. 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 ?

25. 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

27. 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

32. de Vries EN et al. NEJM 2010

33. de Vries EN et al. NEJM 2010

34. Mortality according to SSCL use
van Klei WA. Ann Surg 2012

35. 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

37. Urbach DR. NEJM 2014

38. Urbach DR. NEJM 2014

39. Urbach DR. NEJM 2014

40. Ann Surg 2013

41. 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

42. THE CHECKLIST PARADOX
[title stolen from Lorelei Lingard]
Marlies van Dijk
Director Clinical Improvement
mvandijk@bcpsqc.ca
@tweetvandijk

43. The RIGHT conversation?

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

45. Makary, 2006 Journal of American College of Surgeons

48. “the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical problems.”
Ron Heifetz
48

50. Surgical Culture Change Strategy in BC

51. 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.

52. http://bcpsqc.ca/clinical-improvement/teamwork/resources/

54. 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

56. Interacting in WebEx: Today’s Tools Interagir dans Webex: outils à utiliser
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Be prepared to use:
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57. CONCLUSIONS:
Giuseppe Papia

59. 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

61. c
Carla Williams cwilliams@cpsi-icsp.ca

62. Instructions to download certificate
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