THE SAFE SURGERY CHECKLIST. MORE THAN JUST A GOOD CATCH

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

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

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8 No one can stop an idea whose time has come Voltaire

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10 Rapid dissemination of SSCL 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

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

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

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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 SSC piloted Alberta SSC approved SURGERY SCN PROJECT Transition to Ops Sites self reporting 100% compliance Audited compliance 47% Compliance 93% Compliance 95%

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

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

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

38 Observational Audits

39 Tableau Reports

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:

43 Giuseppe Papia

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

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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

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51 Next steps