1. Surgical Safety Checklist
A story

2. 2008

3. Design
Checklists don’t have to be comprehensive – they need to focus on the critical steps
Getting the wording right – simple, usable, applicable
Pause points – plus briefing and debriefing

4. Aim Create a culture of teamwork
Create rigour and discipline in a high risk process
Get the ‘dumb stuff’ out the way
Reduce harm and save lives

5. 2009

8. I have been trying for some time to understand the source of our greatest difficulties and stresses in medicine.
It is the complexity that science has dropped upon us and the enormous strains we are encountering in making good on its promise.
Atul Gawande

9. Knowledge has both saved us and burdened us.
The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely or reliably.
Knowledge has both saved us and burdened us.
Atul Gawande

10. We need a different strategy for overcoming failure, one that builds on experience …but somehow also makes up for our inevitable human inadequacies.
And there is such a strategy, though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies.
It is a checklist
Atul Gawande

11. Simplicity
Complexity
Profound simplicity
William Schultz

12. Work as imagined versus work as done

13. Or in more detail… Work as imagined Work as prescribed Work as done
Potential fantasy – people who don’t know about real work and imagine what should happen set standards or guidelines for others to enforce and wonder why they don’t work
Work as prescribed
Working ‘by the book’ - work carried out is per the rules or policies because it has to be e.g. radiotherapy
Work as done
The messy reality – work may not be carried in accordance with policy but this is the way in which people get through their tasks or day
Work not as disclosed
Work carried out is not in accordance with official policy and others would find it unacceptable so it is not discussed

14. Incivility
Kindness

15. Kindness [the quality of being friendly, generous, and considerate]
To give and receive kindness increases morale
Everyday Prosociality in the Workplace: The reinforcing benefits of giving, getting and glimpsing -Chancellor J, Margolis S et al; Emotion 2017 June 5

16. [rude or unsociable speech or behaviour]
incivility
[rude or unsociable speech or behaviour]

17. Recipients of minor incivility
experience an immediate loss of cognitive capacity
lose time worrying about the rudeness
reduce the quality of their work
reduce their time at work
take it out on service users
Dr Chris Turner
References via:

19. Incivility shuts people down and silences them Grandstanding Gender Seniority Status Titles Groups

20. Patients pay the price of failed conversations
The inability to speak up
The inability to listen
The failure to respond

21. Avoidable or unavoidable
Are you really listening or are you just waiting your turn to talk?
Robert Montgomery

22. Briefing and debriefing

23. Talk
Listen
Debriefing
Briefing

24. Essential components What went as planned? What went ok?
What would we like to replicate?
What could we do differently?
Anything that needs escalating?
What has been actioned?
What do we need to pass on?
What shall we pick up at the briefing tomorrow?

25. Essential behaviours Facilitation Kindness Respect Curiosity
Speaking up
Listening
Responding

26. What we now know – checklists…
Help people talk to each other
Help people develop relationships however brief
Help with interactions and connections
Give people identity and names
Make the invisible visible
Help people have a voice
Are never about compliance

27. Catalyst Session 1
In the spirit of ‘safety II’.. Discuss the debrief in your organisation…[using trio methodology]
What works well?
What adjustments do people make to ensure things work?
What interpretations are made in order to succeed?
How could we replicate good practice?

28. Trio methodology 3 people 3 rounds of 20 mins each Story teller
Listener
Observer
3 rounds of 20 mins each
Story teller shares what happens in their organisation for 10 minutes
Listener asks clarifying or probing questions for 5 minutes
Observer is the time keeper and feeds back what they have heard and all agree and write down the key messages from the round
THEN each person changes roles until all have played each role

29. Lunch

30. Catalyst Session 2 Step 1 (20 mins) Step 2 (40 mins)
Review notes from catalyst session 1 - across all three stories
What were the challenges?
What worked well?
What adjustments did people make to ensure things work?
What interpretations were made in order to succeed?
What could we do to replicate good practice?
How do we get away from the compliance culture?
Create one flip chart / scribble sheet that describes the 3 things you will do when you get back to work
Step 2 (40 mins)
Feedback session facilitated by Suzette
Build on the 3 things together to find partners and ideas

31. Behavioural insights
Using the findings of the behavioural and social sciences to help people achieve their goals and to improve the effectiveness of policy without requiring anyone to do anything!

32. The by now famous example

33. We are perpetually bombarded by subtle influences and cues
Fire doors
Shop layouts
How a form is written
Advertising
Language

34. Examples Supermarkets – full of behavioural engineering
Colours (reds and greens make each other stand out more)
Prices – 2 for one, one for £2 or three for £5
Packaging
Smells
Checkout items
Changing the colour of an envelope makes it more attractive
Addressing a person by their name can increase the impact of a communication or intervention
Providing immediate feedback changes behaviour e.g. smart speed signs

35. Easy Attractive Social Timely
EAST
Easy
Attractive
Social
Timely

36. Make it easy
People are much more likely to do something if it is easy and low-hassle
Simplify
Remove barriers
Set defaults that provide the path of least resistance

37. Examples Reduce suicide by removing ligature points
Increase pension use by employers who automatically enrol workers into pension plans
The opt in or opt out of organ donation
The settings of your smart phone
Provide prompts or reminders to do something such as diary reminders or computer alerts

38. Make it attractive
People who are drawn to that which catches their attention
Personalise – use people’s names
Make it relevant
Make a key point stand out
Think about the messenger – experts and named individuals beat anonymised or distrusted sources
Incentivise
Use emotion

39. Examples Making something we know we ought to do more appealing
Reward and recognition
Awards
Air miles
Supermarket points
Creating a game which incentives different actions
Being motivated to ‘doing good’ – recycling, towels in hotel rooms

40. Making something attractive by using humour, fun and curiosity
Making healthy food more fun
Cutting food into sun shapes
Games, video content aimed at encouraging people to exercise more
Safety messages on airplanes such as Virgin Atlantic (cartoon with key visuals and music from famous films) or Air New Zealand (delivered by children)

41. Make it social
People are strongly influenced by what others are doing or have done
People are influenced by networks, friends and colleagues
Reciprocity and active commitments or promises trigger action

42. Reciprocity
Someone on the train goes to the toilet leaving their bag and someone tries to steal it
Most would not intervene
Someone catches your eye and smiles at you as they go to the toilet leaving their bag and someone tries to steal it
You are more likely to intervene
Someone turns to you and asks you to keep an eye on their bag while they are away and someone tries to steal it
Most would intervene

43. Social influences
Know about what influences the social context you are working in
How people influence each other, the body language, the words used, how people follow
Understand the social norms, rules, behaviours and values of the people you want to change
The power of the group – the diffusion of responsibility e.g. the famous ‘smoke filled room’
The power of the clues

44. Social - shock tactics Anti-smoking campaigns
Road traffic accident campaigns
Calorie labelling rather than units of alcohol on drinks
a glass of wine is equivalent to a slice of cake

45. Examples
We are 8 times more likely to drop a flyer if others are already on the ground
We are more likely to comply with environmental behaviours (not having the sheets changed every day) if we know that is what other people do
7 times more likely to give a donation when a colleague has already done so

46. Make it timely
Interventions are more effective before habits have formed or the behaviour has been disrupted
Examples:
We are more likely to give to charity before Christmas
People who have suffered a heart attack may desire advice about how they and others in their family might change their behaviour
Adults may become more interested in their own learning when their children start going to school
People who have moved from being unemployed may be more happy to help someone else in the same situation

47. Communication It matters who the messenger is
Role modelling – the behaviours of others shapes and amplifies what we do
Tone, style and language
Be human, be personal