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Webinar 15: Coaching the Checklist Continued. Summary of Last Week’s Call Gave you one more tip on coaching. Case Studies Continued. Coaching 101: –Purpose.

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Presentation on theme: "Webinar 15: Coaching the Checklist Continued. Summary of Last Week’s Call Gave you one more tip on coaching. Case Studies Continued. Coaching 101: –Purpose."— Presentation transcript:

1 Webinar 15: Coaching the Checklist Continued

2 Summary of Last Week’s Call Gave you one more tip on coaching. Case Studies Continued. Coaching 101: –Purpose of coaching –Choosing the right people to be coaches –Providing feedback to surgical teams

3 How Did the Homework Go?

4 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 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.

5 Homework to Date Slide 2 of 4 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. us your hospital’s checklist. If you haven’t already done so, please call or our team about whether you would like to administer the culture survey. everything to Identify people that you think will be skeptical of using the checklist and try to talk to them before you hold a large meeting.

6 Homework to Date Slide 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.

7 Homework to Date Slide 4 of 4 Continue to: –Administer the culture survey –Have one-on-one conversations with as many people as you can –Hold departmental meetings –Implement the checklist Create a checklist demonstration video and consider submitting it to the video competition. Mark your calendars and register 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.

8 Today’s Topics Polls Last week’s case study results Case studies Coaching Continued: –A quick review –When to coach in the OR –“Let’s Head into the OR” – Coaching Demo

9 Poll: Have You Finalized Your Checklist Yes No, we are still making minor modifications to the checklist

10 The 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 on their implementation team. 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. Last Week’s Case Study: A Quick Review & Results

11 Last Week’s Case Continued They did try to have someone from the implementation team in the OR to watch 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.

12 Last Week’s Case 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.

13 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.

14 Your Feedback to The Team At Harvard Hospital

15 What do you think happened? “The timeline became the goal, not successful implementation.” “The successful rooms were the two rooms with Surgeon Champions.”

16 Why were they successful with two of the surgeons and not the rest? “Got buy-in and took the time to hardwire the process effectively.” “There was commitment from the surgeon champions and time invested by these surgeons to ensure the process was successful.”

17 How would you fix it? “Re-establishing the communication process, then make sure goal is identified properly and correct priority is established, allow adequate time for acceptance.” “Educate all physicians, have surgeons understand the importance of surgical checklist in relation to positive patient outcomes intra and post op.”

18 The Next Case

19 The Facts A heart surgeon, an enthusiastic supporter of checklists, decided to try out a checklist he had been working on to use in heart surgery. While it was based on the South Carolina Surgical Safety Checklist, it had been thoroughly modified to meet the special needs of heart surgery. He had assembled a group to modify the checklist that consisted of an anesthesiologist, cardiac surgery nurse, another heart surgeon and a perfusionist who runs the heart lung machine. Everyone who worked on the checklist was very enthusiastic. They group did a table top simulation in the conference room where they met about once a month while working on their checklist.

20 The surgeon decided to try out his checklist during a relatively straight forward heart operation on a 70 year old man who needed a bypass operation. None of the members of the team that had helped to modify the checklist were in the operating room that day. The nurse, anesthesiologist and perfusionist, who were well acquainted with the Joint Commission time out, had never seen the checklist before they used it that morning. Because the surgeon wanted to be able to show that the checklist didn’t take too long, each portion of the checklist was timed that morning. No one had practiced using the checklist before they used it. The case went well. A survey was given to all of the surgical team members at the end of the procedure asking them their opinions about how the checklist had gone. To the surgeon’s surprise, no one on the operating team was enthusiastic about using the checklist again. In fact, most of the team felt that the checklist was useless and if they were to have surgery, definitely wouldn’t want a checklist used for them. They never wanted to use the checklist again.

21 Give Harvard Hospital Your Feedback 1.If you could give the surgeon just one piece of advice, what would it be? 2.In getting ready to use the checklist for the first time in the operating room, how should people on the operating room team be prepared?

22 Coaching in the OR Continued Dabo Swinney Steve Spurrier

23 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

24 Telling Criticizing What Coaching Isn’t

25 Who Makes a Good Coach? The best coaches are: –Coachable –Respected by their peers –Understand how to give feedback

26 Show Me/Teach Me Watch Me Give Me Feedback COACHINGCOACHING

27 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.

28 When You Give Feedback Keep it simple Keep it focused Be respectful Be kind

29 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?” ObservationOpen Ended Question

30 "I am curious..."

31 Questions Should Be Focused and Avoid Generalizations “I noticed that the checklist was done in a sloppy and haphazard way" Instead, give specific examples.

32 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.

33 Remember, you are coaching the team

34 Think About What you saw Who you are talking to –Talk to the team –Will coaching be effective for this team Is the culture ready for coaching in the OR? Should I coach in a one-on-one setting? Am I right the person to coach? What is going on in the OR

35 Let’s Head into the OR

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37 How would you have coached the team to remember the Heparin? Write it on a sticky note Use memory Write it on the white board Paging the surgeon right away It wasn’t appropriate to coach the team about the heparin at this point in the case.

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39 As the coach, what would your reaction be to the surgeon saying, “Speak now or forever hold your peace?” It was okay for the surgeon to say that. I shouldn’t say anything. It is not okay for the surgeon to say that and I should talk to the surgeon about this now. It is not okay for the surgeon to say that and I will talk to him alone following this case.

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41 1. How do you think the coach did? Give him a grade: –A = Excellent –B = Above average, but it could have been improved –C = Average –D = Below Average –F = Poor 2. What would you have done differently, if anything?

42 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 Create a checklist demonstration video and consider submitting it to the video competition. Deadline for the competition is April 6 th. Mark your calendars and register 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.

43 ? ? Questions

44 Ask Us a Question By Using the Raise Hand Button

45 Office Hours: Next Tuesday from 2:00- 3:00

46 Next Call: We Need Your Feedback & Measuring Checklist Use and Impact in Your ORs March 22 nd, :00-3:00

47 Resources Website:


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