Transcript What are People Saying Across the Country_ Qualitative

What People are Saying
Across the Country:
Qualitative Interview Results on Surgical
Safety Checklist Implementation
Cari Egan − Safer Healthcare Now!
www.saferhealthcarenow.ca
Highlights
• Background
• Study Findings
• Where do we go from here?
www.saferhealthcarenow.ca
Background
• Up to 70% of in-hospital adverse events occur during the perioperative period, yet up to 50% are preventable.1,2
• The Surgical Safety Checklist (SSC) has been shown to reduce
mortality and morbidity among surgical patients and promote
teamwork and communication between the surgical team.3
• Improved patient outcomes have been connected to
communication, team functioning, and culture change in the
operating room.4,5
www.saferhealthcarenow.ca
Methods
• Qualitative Descriptive Quality Improvement Project
• Convenience and Snowball Sample
• 11 semi-structured Interviews conducted (10 one-on-one,
1 focus group) with key stakeholders
• 6 OR Nurses [2 Educators, 1 Clinical Specialist, 3
Managers]
• 2 Anesthetists
• 3 Surgeons
• 1 Human Factors Specialist
• 1 Quality & Performance Improvement Coordinator
www.saferhealthcarenow.ca
Findings
Measure for compliance and not much else
If you audit [a] group who says that they are doing [t
he SSC] 97%... the same group is reporting 40‐70%
antibiotics are given at the appropriate time bef
ore surgery. It should be a force function…they s
houldn’t start [surgery] until they have given anti
biotics. Anesthetist
If I had to rate my colleagues [checklist] interest and
knowledge and practice I would give them a ‘D’. The
checklist is not taken seriously. Anesthetist
www.saferhealthcarenow.ca
Findings
Key Themes
1. Haphazard “roll out” of the Surgical Safety Checklist
2. Interdisciplinary team communication: Far from
embedded in operating room culture
3. Inter-professional communication in the operating
room is impacted by the time pressures and divergent
workflow patterns
www.saferhealthcarenow.ca
Haphazard “Roll out” of the Surgical Safety
Checklist
“The checklist in [large healthcare centre] was not
rolled out well at all. [Someone with experience with
the SSC] came and gave a talk, but there wasn’t a big
explanation of what was going to be expected during
this process. Most people found out about the
checklist during their business meetings, we were just
told that we were supposed to start using a
checklist…We were told very little. There was no
discussion or presentations…not even during rounds.
So it is not surprising that people just came up with
road blocks on why they couldn’t use it. It was just
rolled out from the top down.” Surgeon
www.saferhealthcarenow.ca
Haphazard “Roll out” of the Surgical Safety
Checklist
Facilitators
• Buy In
• Physician Champions
• Education
• Pilot Testing
Barriers
• Disengagement with Administration
• Stubborn Pride
• Inefficient Use of Operating Room Time
• Lack of Reward
www.saferhealthcarenow.ca
Interdisciplinary Team Communication: Far from
Embedded in Operating Room Culture
“[…]in some circumstances it [checklist] actually causes
conflict which is, I mean in any OR there is this ongoing
power struggle between anesthetists and the surgeons,
you have very hierarchical this top down going on, you’ve
got the surgeons ruling the show and the anesthetists and
surgeons power struggle always going on there. None of
that is particularly good in terms of focusing on the case,
and that is essentially what the checklist is supposed to
do”. Anesthetist
www.saferhealthcarenow.ca
Inter-professional communication in the OR Impacted
by Time Pressures and Divergent Workflow Patterns
“Nurses would like surgeons actually present.
Surgeons are often not present for parts of the
checklist, either the briefing or debriefing”.
OR Nurse Manager
www.saferhealthcarenow.ca
Where do we go from here?
• Regular audits (monthly)
• Consolidate patient assessments by nursing, anesthetics
and surgeons by doing briefing
• Celebrate investment and participation in the checklis
• Teamwork and Communication
www.saferhealthcarenow.ca
• Thank you to all of the participants in this project
• Thank you to my colleagues on the SHN! Surgical Safety Checklist
Metric Planning Group:
Marlies van Dijk, Western Node Leader Safer Healthcare Now!
Tanis Rollefstad, Western Node SIA Safer Healthcare Now!
Leanne Couves, Improvement Associates Ltd.
Virginia Flintoft, Project Manager Central Measurement Team, SHN!
Ioana Popescu, Surgical Safety Checklist Project Manager, CPSI
www.saferhealthcarenow.ca