Webinar 17:
Teamwork in The Operating Room
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
How Did the Homework Go?
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.
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.
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.
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 interdisciplinary meeting that you scheduled at the beginning of
the call series.
Today’s Topics
• Teamwork in the Operating Room
– Overview
– The Checklist as a Teamwork Tool
– Closed Loop Communication
– Speaking Up
Teamwork in the
Operating Room
Poll 1: Are you or one of your
colleagues planning on
attending the April Patient Safety
Symposium?
• Yes
• No
• I am not sure yet
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.
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.
Nundy, S, et al. Impact on Preoperative Briefings on Operating Room Delays: A Preliminary Report. Arch Surg. 2008 Ovember;
143(11): 1068-1072.
Mazzocco, K, et al. Surgical Team Behaviors and Patient Outcomes. The American Journal of Surgery: 678-685, 2009.
OR Team Training Program
What We Created
20 Minute
Presentation
Exercise
Team Training Topics
• The Checklist as a Means to Enhance
Teamwork in the OR
• Closed Loop Communication
• Speaking Up
• Coaching in the OR
3 Spots Left For April 24th
Team Training
Contact Mary Stargel to register:
mstargel@scha.org
The Checklist Can Be
Poor Man’s Team Training
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
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.
Coaching Teamwork in the
OR
Teamwork
Coaching
Tool
Closed Loop Communication
5. Verbal communication among team members was easy to
understand (e.g., clearly articulated and spoken at an adequate
volume.)
7. Speakers made a visual or spoken effort to confirm that
important information was received.
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
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.”
Checklist
Teamwork
3. Physicians were present and actively participating in patient care prior to skin incision.
4. Physicians maintained a positive tone throughout the operation.
13.Team members referred to each other by role instead of name (e.g. “Nurse” instead of
“Dana”).
 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.”
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.
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.
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.
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.
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 6th.
• Mark your calendars and register to attend the 2012 April
Patient Safety Symposium.
• If you have not already done so, hold the large interdisciplinary meeting that you scheduled at the beginning of
the call series.
Next Call:
Keeping the Checklist
Going . . . It will be our
last call for a few months
April 5th, 2012
2:00-3:00
Questions
Ask Us a Question By Using the
Raise Hand Button
Office Hours:
Next Tuesday from 2:003:00
Resources
Website:
www.safesurgery2015.org
Email: safesurgery2015@hsph.harvard.edu