1. Webinar 17: Teamwork in The Operating Room

2. Summary of Last Week’s Call Case Study Results from Last Week Measuring the Checklist 101: –Checklist Use –Positive Impacts on patient care –Outcomes Mortality Complications We asked for your Feedback about the Webinar Series

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 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.

5. Homework to Date Slide 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.

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 Teamwork in the Operating Room –Overview –The Checklist as a Teamwork Tool –Closed Loop Communication –Speaking Up

9. Teamwork in the Operating Room

10. Poll 1: Are you or one of your colleagues planning on attending the April Patient Safety Symposium? Yes No I am not sure yet

11. Poll 2: Reflect on the cases that you have been a part of or observed over the last month and rate your perceptions of teamwork (1 = Never, 5 = Always) 1.Physicians maintained a positive tone throughout the operation. 2.Speakers made a visual or spoken effort to confirm that important information was received. 3.Team members referred to each other by role instead of name (e.g., “Nurse” instead of “Dana”) 4.Team members made certain that their concerns were understood by other team members.

12. Lingard, L et al. Evaluation of Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication. ARCH SURG. VOL.143 January 2008.

13. Nundy, S, et al. Impact on Preoperative Briefings on Operating Room Delays: A Preliminary Report. Arch Surg. 2008 Ovember; 143(11): 1068-1072.

14. Mazzocco, K, et al. Surgical Team Behaviors and Patient Outcomes. The American Journal of Surgery: 678-685, 2009.

15. OR Team Training Program

16. What We Created 20 Minute Presentation Exercise

17. Team Training Topics The Checklist as a Means to Enhance Teamwork in the OR Closed Loop Communication Speaking Up Coaching in the OR

18. 3 Spots Left For April 24 th Team Training Contact Mary Stargel to register: mstargel@scha.org

19. The Checklist Can Be Poor Man’s Team Training

20. Closed Loop Communication 1.The sender initiates a message. 2.The receiver accepts the message, interprets it, and confirms what was communicated. 3.The sender verifies that the message was received. Derived from the Agency for Healthcare Research and Quality, TeamSTEPPS

21. Speaking Up: The Solution Use special words that indicate that there is a problem. Both the sender and the receiver need to understand these words.

22. Coaching Teamwork in the OR

23. Teamwork Coaching Tool

24. 5. Verbal communication among team members was easy to understand (e.g., clearly articulated and spoken at an adequate volume.) Closed Loop Communication Nurse review with Team:  Instrument, sponge and needle counts are correct  Name of the procedure performed  Specimen labeling −Read back specimen labeling including patient name 7. Speakers made a visual or spoken effort to confirm that important information was received.

25. Speaking Up 17. Team members made certain that their concerns were understood by other team members.  Everyone please state your name and role. Surgeon discusses:  Operative plan and possible difficulties  Expected duration of procedure  Anticipated blood loss  Implants or special equipment needed Anesthesia Provider discusses:  Anesthetic Plan  Airway or other Concerns Nursing Team Discusses:  Sterility, including indicator results  Any Equipment Issues or other concerns Surgeon States: “Does anybody have any concerns? If you see something that concerns you during this case, please speak up.”

26. Checklist Teamwork 13.Team members referred to each other by role instead of name (e.g. “Nurse” instead of “Dana”). 3. Physicians were present and actively participating in patient care prior to skin incision. 4. Physicians maintained a positive tone throughout the operation.  Everyone please state your name and role. Surgeon discusses:  Operative plan and possible difficulties  Expected duration of procedure  Anticipated blood loss  Implants or special equipment needed Anesthesia Provider discusses:  Anesthetic Plan  Airway or other Concerns Nursing Team Discusses:  Sterility, including indicator results  Any Equipment Issues or other concerns Surgeon States: “Does anybody have any concerns? If you see something that concerns you during this case, please speak up.”

27. Who Should Complete This Tool? Observers, i.e. members of the checklist implementation team, nurse educators, nurse managers, quality improvement officers. Observers should stay for at least 30 minutes of a given case. We recommend that you limit the number of people that are performing the observations so you will get consistent feedback.

28. Pairing This Tool With the Checklist Observation Tool To better understand how the checklist affects teamwork, we recommend that both of the coaching tools be used in the same case. The circulating nurse should complete the Checklist Coaching Tool and an outside observer should complete the Teamwork Coaching Tool. Another option is to have two outside observers complete the tools.

29. How Many To Collect In order to give you the best feedback we suggest collecting a minimum of 10 observations per quarter. –If you perform more than 10 per quarter you will have a better understanding of checklist use and teamwork. –If you perform fewer observations we will still give you feedback.

30. We Will Give You Feedback Based on the Observations If you send our team your completed tools we will give you a report on how your hospital is doing. These reports are extremely helpful and are offered to you at no cost. We recommend that every hospital use this tool to better understand how the checklist is used.

31. 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.

32. Next Call: Keeping the Checklist Going... It will be our last call for a few months April 5 th, 2012 2:00-3:00

33. ? ? Questions

34. Ask Us a Question By Using the Raise Hand Button

35. Office Hours: Next Tuesday from 2:00- 3:00

36. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu