Webinar 14:Improving the Use of the Checklist

Through Coaching

Summary of Last Week’s Call• Engaging your colleagues at meetings

continued.

• SCHA Hospital Visits: Opportunities for Improving Checklist Use.

• Case Studies.

How Did the Homework Go?

Homework to Date Slide 1 of 4

• Build an implementation team.

• Schedule a time and venue for a meeting to take place after January.

• Download the OR Personnel Spreadsheet from our website and begin completing the information with the names, roles, and email addresses if relevant.

• Review the checklist modification guide and South Carolina Checklist Template.

• Modify the checklist with your implementation team and use it in a “table-top simulation”.

• Test the checklist with one team and modify if necessary.

Homework to DateSlide 2 of 4

• Email us a picture of your checklist implementation team.

• Identify departmental meetings to have the implementation team speak after call 10.

• Expand the testing of the checklist to one team using the checklist for every case for one day. Modify the checklist as necessary.

• Email us your hospital’s checklist.

• If you haven’t already done so, please call or email our team about whether you would like to administer the culture survey.

• Email everything to safesurgery2015@hsph.harvard.edu.

• Identify people that you think will be skeptical of using the checklist and try to talk to them before you hold a large meeting.

Homework to DateSlide 3 of 4

• Organize and conduct one-on-one conversations.

• Create a checklist demonstration video for your hospital.

• Decide if the checklist will be used in paper or poster form.

• Finalize your hospital’s checklist, please send it to us so we can see how you made the checklist work for you.

• Start your checklist advertizing campaign.

• Prioritize surgical specialties for the roll-out using your knowledge of which surgeons will be most receptive to the checklist.

• Create a timeline for your hospital’s expansion and send it to the Safe Surgery 2015 team.

Homework to DateSlide 4 of 4

• Mark your calendars for the April Patient Safety Symposium (April 24th – 26th).

• Continue to hold departmental meetings in the service that you are putting the checklist into place next.

• If you haven’t already, hold the large inter-disciplinary meeting that you scheduled at the beginning of the call series.

• Start implementing the checklist over the next week with the service/surgeons that you think will be most receptive.

Today’s Topics• One more tip on engaging your colleagues.

• Case Studies Continued.

• Coaching 101:

– Purpose of coaching

– Choosing the right people to be coaches

– Providing feedback to surgical teams

Committees and People To Consider Presenting To About

the Checklist:• Nursing and Anesthesia Staff

• Perioperative Services Committee

• Quality Oversight Committee

• Board Quality Meeting

• Medical Administrative Committee

• Every Surgical Service Line

Case Studies Continued

• I need your help

• You are experts in implementing checklists in the OR. We are going to practice giving advice by “solving problems”

• “Hospitals helping Hospitals”

Last Week’s Case Study: A Quick Review & Results

Harvard Hospital built an inter-disciplinary implementation team to customize and test the

Surgical Safety Checklist. The team that tested the checklist was happy with the content and thought that

it worked well in their operating rooms. The implementation team wanted to test the checklist with additional surgical teams to make sure that it worked

before finalizing the checklist. Over the next two weeks they spread the checklist to other surgical teams and collected feedback. The feedback that they received

was that the checklist was too long and that the physicians did not want to keep using it.

The Results from the Case Study from Last Week

What would you do if this happened to you:

“I would ask the team members to tell me in writing what they felt like could be eliminated. I would review this

information with the development team and make decisions on whether to shorten or not.”

“Ask for specific feedback.”

“What components were too long? Someone from the checklist team should go in and observe [a case] to ensure

it was used correctly.”

The Case

They had the best of intentions. They planned and thought they had taken

enough time to put the checklist into place, but 3 months later in an audit, it was clear that they weren’t where they wanted to be.

What happened?

The FactsThe team at Harvard Hospital spent 2 months in small

scale testing and refinement of their checklist. They had two fully engaged surgeon champions and an enthusiastic anesthesiologist. They met, did table

top simulation and then introduced the checklist into two operating rooms – out of a total of 40 in the

hospital. Then they mapped out a plan to introduce it to the rest of the OR. They ranked the services in order of difficulty. But they tried to be “aggressive” with their timeline and wanted to go from 2 ORs to

40 in less than a month.

The Facts Continued

They did try to have someone from the implementation team in the OR each time a new surgeon used the checklist – to answer

questions and to make sure that the checklist was being used the “right way”. But they only watched once for each surgeon and

then moved on. They had a lot of work to do.

They met their goal on time. Every OR in one month. Success. 

The Facts Continued

They went back 3 months later to check – did an “audit” and found that over half of the time the checklist wasn’t being used.

In fact, they even saw times when the Joint Commission time out wasn’t being done. But in the OR’s where they had

started – the two surgeons were still using the checklist – and using it well.

Poll

1. What do you think happened?

2. Why were they successful with two of the surgeons and not the rest?

3. How would you fix it?

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.• 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.

Coaching in the OR

Dabo SwinneySteve Spurrier

Learning How to Drive

• A PowerPoint presentation

• A drivers manual

• The car keys and the freeway…

Knight, Jim. Instructional Coaching. California: Corwin Press, 2007. Print

Another Way

• A PowerPoint• A drivers manual• An introduction to the car• A lot of practice driving with a “coach”• Freedom

Knight, Jim. Instructional Coaching. California: Corwin Press, 2007. Print

• Listening and watching

•Asking questions about what you see or hear

• Trying to improve people’s performance

•Getting people to understand how to help themselves

What is Coaching?A Quick Review

• Telling

• Criticizing

What Coaching Isn’t

Who Makes a Good Coach?

• The best coaches are:– Coachable– Respected by their peers– Understand how to give feedback

Show Me/Teach Me

Watch Me

Give Me Feedback

COACHING

Think About

• What you saw

• Who you are talking to– Talk to the team

• What is going on in the OR

Your Observation• What you saw

– Be specific and clear.

– Avoid telling people why you think they did what they did.

– Do not fill in gaps, ask the person “why they think they did what they did”

– Stay away from telling somebody that they did something bad or that they need improvement.

When You Give Feedback

• Keep it simple

• Keep it focused

• Be respectful

• Be kind

Ask Questions

Your questions should have two parts:1. State your observation and opinion.

2. Ask an open ended question designed to help you understand better what happened.

The Second Part

• The second part of the question is really important.

• It will help the team reflect on what happened and if done properly help them to understand why.

Ask Questions

• “I noticed that . . . can you help me understand?”

• “I saw that you . . . . . can you explain?”

• “I observed that you . . . . What could you have done differently?”

Observation Open Ended Question

"I am curious..."

Questions Should Be Focused and Avoid

Generalizations

“I noticed that the checklist was done in a sloppy and haphazard

way"

Instead, give specific examples.

Questions should avoid focusing on things that you

can't see:

"I noticed that you carelessly..."

The Coach as a Motivator

• Emphasize positive things that you observed during the case.

• Tell them that they can be even better and how they can do that.

Remember, you are coaching the team

This Week’s Homework• Continue to:

– Administer the culture survey.

– Have one-on-one conversations with as many people as you can.

– Hold departmental meetings.

– Implement the checklist

• Mark your calendars to attend the 2012 April Patient Safety Symposium.

• If you have not already done so, hold the large inter-disciplinary meeting that you scheduled at the beginning of the call series.

Video Competition: Deadline April 6th

Winners Will Be Announced at The Patient Safety Symposium

??Questions

Ask Us a Question By Using the Raise Hand Button

Office Hours:

Next Tuesday from 2:00-3:00

Next Call: Coaching with the Observation ToolsMarch 15th, 2012

2:00-3:00

Resources

Website:www.safesurgery2015.org

Email: safesurgery2015@hsph.harvard.edu