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As I stated in my commentary earlier in the month, surgical safety checklists are key tools that can help surgical teams avoid error while facilitating communication amongst team members. These checklists, however, must be implemented strategically to impact patient safety to the fullest degree possible.
Recently, a series of articles has been published looking at this issue of how best to implement a checklist, including one by Dr. Dante M. Conley now available online only in the Journal of The American College of Surgeons. In the article, “Effective Surgical Safety Checklist Implementation,” Dr. Conley and his colleagues studied the surgical safety checklist implementation processes in five Washington State hospitals and through a series of interviews, measured the subsequent use and effect of the checklist on patient outcomes. They concluded that the effectiveness of the checklist “hinges on the ability of implementation leaders to persuasively explain why and adaptively show how to use the checklist.” When hospital leadership explained the rationale for implementing the checklist and provided education alongside its use, surgical teams were found more likely to use the checklist and buy-into the process. When this did not occur, staff ultimately became frustrated and uninterested and stopped using the checklist despite a hospital-wide mandate.
In a 2005 study, “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives,” the American Association of Critical-Care Nurses (AACN), the Association of periOperative Registered Nurses (AORN), and VitalSmarts found that even with the use of surgical safety checklists, members of surgical teams still decide not to speak up, “even when safety tools alert them to potential harm.” Study authors found that the majority of surgical team members had witnessed their colleagues taking dangerous shortcuts, displaying incompetence, and/or being disrespectful of their team members and undermining their concerns. The authors suggested this behavior is often entrenched and takes more than one person’s motivation and skill set, and more than a mandated surgical safety checklist for a change to occur. Creating a healthy work environment requires a multi-faceted approach that includes a surgical safety checklist, but also includes empowering education that makes candor and team communication core competencies.
Transforming a surgical team to a more collaborative practice model requires that those doctors and nurses receive similar education and share a common language. The value of the APS Surgical Safety Curriculum is its ability to empower the clinical care team, so use of the checklist grows not solely by the force of an individual’s character, but with knowledge that is compounded by experience. Only when a surgical team is educated how and why to use the checklist, can we begin to see its use increase and realize its potential to greatly improve patient safety and patient and employee satisfaction.
Dr. Martin November, Chief Medical Officer Dr. November is an OB/GYN physician and was a member of the teaching faculty at Harvard Medical School for more than 10 years. He held various administrative positions at the Beth Israel Deaconess Medical Center including Director of the Division of Community Medicine. His academic research focused on patient safety, cost effectiveness analysis, and process improvement in healthcare. He worked with researchers at the Harvard School of Public Health on The Malpractice Insurers’ Medical Error Prevention Study (MIMEPS), a nationwide study of malpractice claims and medical errors. Prior to joining APS in 2008, Dr. November worked with the Harvard Business School Healthcare Initiative to develop the first Harvard Business School Health Science and Business Immersion Program in January 2006. He earned a Bachelor of Arts degree at Duke University, a Doctor of Medicine degree at the University of North Carolina at Chapel Hill, and a Master of Business Administration degree at the Harvard Business School.