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 of coaching
– Choosing the right people to be coaches
– Providing feedback to surgical teams
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 [email protected].
• 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
• 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
Poll: Have You Finalized Your
Checklist
• Yes
• No, we are still making minor modifications
to the checklist
Last Week’s Case Study:
A Quick Review & Results
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 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.
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.
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.
Your Feedback to The Team
At Harvard Hospital
What do you think happened?
“The timeline became the goal, not successful
implementation.”
“The successful rooms were the two rooms with
Surgeon Champions.”
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.”
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.”
The Next Case
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.
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.
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?
Coaching in the OR
Continued
Steve Spurrier
Dabo Swinney
What is Coaching?
A Quick Review
• 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 Coaching Isn’t
• Telling
• Criticizing
Who Makes a Good Coach?
• The best coaches are:
– Coachable
– Respected by their peers
– Understand how to give feedback
Show Me/Teach Me
C
Watch Me
O
A
C
H
I
Give
Me
Feedback
N
G
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.
When You Give Feedback
•
•
•
•
Keep it simple
Keep it focused
Be respectful
Be kind
Ask Questions
Observation
Open Ended
Question
• “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?”
"I am curious..."
Questions Should Be
Focused and Avoid
Generalizations
“I noticed that the checklist was
done in a sloppy and haphazard
way"
Instead, give specific examples.
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.
Remember, you are
coaching the team
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
Let’s Head into the OR
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.
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.
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?
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.
Questions
Ask Us a Question By Using the
Raise Hand Button
Office Hours:
Next Tuesday from 2:003:00
Next Call:
We Need Your Feedback
& Measuring Checklist
Use and Impact in Your
ORs
nd
March 22 , 2012
2:00-3:00
Resources
Website:
www.safesurgery2015.org
Email: [email protected]