Talking to Surgeons
Presentation Guide and Tips for a Surgeon Audience
This document is a guide and tip sheet for the presentation template that was created for surgeons. The corresponding presentation is called “Presentation Template_Surgeon” and can be downloaded by clicking here. Many of the slides in this presentation are also in the template that was provided for you to give at a large multi-disciplinary meeting. The slides that are unique to this presentation are:
Materials to Distribute at the Meeting:
- New England Journal of Medicine Article, “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population”. Click here to download.
Presenter:
If possible, we recommend that the surgeon on your implementation team gives this presentation.
Slide Details:
Slide 1: Insert your hospitals logo, names of people on the checklist implementation team, and your hospital’s name.
Slide 2: Show a picture of your hospital’s implementation team - especially if there are members of the team that cannot attend the meeting.
Slides 3-7: We recommend that you open the presentation by telling a story of something that the checklist could have prevented. We provided a story that you can use in the slides, but many people have told stories about something that they have seen or heard. If you tell your own story, make sure that it cannot be identified with anybody from your hospital.
Please note, this is the same story that was provided in the large multi-disciplinary meeting template.
Slide 8: Many hospitals have asked people in the audience to share a story of something that happened to them. We recommend that you identify somebody that will be attending the meeting beforehand and ask them to share their story. In general, people will talk if one person starts.
Slide 9: This slide is a summary of the Safe Surgery 2015: South Carolina Initiative.
Slide 10: This slide summarizes the studies that have been published on using a surgical safety checklist. Please click on the below links to access the articles that are mentioned:
- New England Journal of Medicine, “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population”. Please note, this is the same article that is listed under materials to bring to the meeting.
- Association Between Implementation of a Medical Team Training Program and Surgical Mortality.
- Effect of a Comprehensive Surgical Safety System on Patient Outcomes
Slide 11: Virginia Mason Hospital was one of the earliest adopters of the Checklist, and what they found was it’s not Checklist that changes patient care, it’s how people use it.
Slide 12: The South Carolina Checklist Template was developed specifically for South Carolina Hospitals. In particular, the briefing and debriefing sections have been expanded. This checklist was created through the consensus of the Safe Surgery 2015: South Carolina Leadership Team.
Slide 13: We recommend that you show your hospitals customized checklist.
Slide 14: Summarize what items you changed on the checklist and how they fit the culture and needs of your hospital. We also recommend that you briefly talk about how you tested the checklist with multiple surgical teams to ensure that it met the needs of your ORs.
Slide 15: “Don’t we already do all of this?” is the most common question that people ask when somebody first learns about the checklist. We have provided some helpful responses in this slide.
Slide 16: If you have created a checklist demonstration video, we recommend that you show it on this slide. If you are still working on this or prefer to use another video you can find videos of surgical teams using the checklist by clicking here.
Instead of using a video some hospitals role-play using the checklist at this meeting.
Slide 17: This is a chance to remind everyone that although we are all very, very good at what we do, all of us can be better. Just like professional athletes and politicians who are at the top of their respected fields, every surgeon and every nurse can be better at what they do, too.
Slide 18: Surgeons in particular need to be aware that we’re not quite as good as we think. There’s a discrepancy between what we surgeons think of ourselves and what the other people on our team think about us. This slide shows that you get very different results when you ask surgeons and OR Nurses to rate each other’s communication and teamwork abilities. 87% of the time the surgeons think the nurses are good teammates. But when you ask the nurses if they think the surgeons are good teammates, you get a very different picture. It’s this gap that we’d like to close. We’d like both of those bars to sit up near the top of the chart so that the surgeons and the people around them are in agreement that the teamwork on our ORs is really, really good.
Slide 19: The slide “How Can the Checklist Help Us Be Better?” summarizes some of the benefits that we have seen in hospitals throughout the world when they effectively use the checklist.
Slide 20:The most critical factor in the successful and meaningful use of something like the Checklist is its acceptance by the physician community, and by anesthesiologists and by surgeons in particular. If any member of the OR team is not fully engaged, the Checklist cannot do all of the things we know the Checklist is capable of doing.
Slide 21: Surgeons often forget and that how they act during the Time Out or during the Checklist really matters. Many times the Time Out is met with disengagement, eye rolling, or other kinds of body language that’s suggestive of a lack of respect for what the Joint Commission is trying to stop.
Slide 22:Use this slide to discuss the ways we currently feel about the Checklist when it’s introduced at the outset of an operation.
Slide 23: The Scrub Sink Trance is a period of time that happens for surgeons as they scrub in when they actually begin to do the surgery in their minds. As they’re scrubbing, they’re beginning to review the first critical steps of an operation, or maybe the most critical steps of the operation they’re about to perform. One of the most common criticisms of the Joint Commission Universal Protocol is that it breaks up this trance.
All experts have their own versions of the Scrub Sink Trance. People who ski, people who bike, people who speak, people who do surgery all have this period of intense focus before they begin. The downside of this trance is that when you’re in it, you’re partially disengaged and you are much more vulnerable to forget things that you really mean to do. This is why the Checklist is so important – because the Checklist makes you stop, come out of your trance, and make sure you get all of the critical steps done. This quick switch from a state of intense focus to a state that is not nearly intense is just what baseball players do when they step in and out of the batters box, and it’s something that surgeons need to learn how to do.
Slide 24: Surgeons can make a difference, and our plea to all the surgeons out there is we have an obligation to make a difference. It’s our responsibility to work to improve the safety and outcomes of our patients. The system can’t do it without us. Even though we may feel like it, we are not powerless to change things for the positive.
Slide 25: The Checklist is the surgical community’s chance to improve the teamwork that is in their operating rooms. It can make the patients’ outcomes better, and it can make the surgeon’s life better because people will work together better. It’s all about communication and coordination, about a place where the performance of the team is valued over our individual performance, where we use resources wisely, and where we take opportunity to exert the leadership that we know is part of who we are as surgeons.
Slide 26: So what can a surgeon do? A surgeon can try and use the names of the people around them – by using the introductions part of the Checklist to encourage people to introduce themselves and/or by using white boards in operating rooms that we can glance at it if we forget somebody’s name, particular under pressure. Name recognition activates people. It raises their level of awareness, and it also shows them respect. Looking over the ether screen and saying “Anesthesia” is rude, and we all know that. We do it because we can’t remember the anesthesiologist’s name, perhaps, but using a name in that situation is incredibly helpful for the relationship as well as for patient care.
One of our major responsibilities as surgeons is to set the tone at the beginning of the operation. We want a positive tone of openness and one that encourages people to speak up – particularly if patient safety is threatened.
Slide 27:It’s very important for us as surgeons to remember that this whole thing isn’t about the surgeon. If anything it’s about the patient. Everybody in the room is there for the patient, and all the people that surround us as surgeons need our help, encouragement, and leadership. Surgery is a team effort, and the most effective and safe surgeons recognize that.
Slide 28 – “Safety is staying back from the Edge”: This is a little picture to show you what the Checklist can do and why I think it’s so important for surgeons to take control of the parts of the Checklist that they are responsible for – and that’s mostly around the time of the Time Out. Safety is staying back from the edge of the cliff. We don’t want our patients to fall off. Most of us spend our time up on the edge there, but we want to be back further than that so if something goes wrong there’s more margin. The Checklist can help us stay back from the edge.
Slide 29: The checklist has already helped. Many hospitals have monitored items that the checklist has caught since they started using it in the testing phase. This is a chance to summarize any of the things that the checklist has caught. We also recommend for a member of one of the surgical teams that tested the checklist share their experiences using the checklist and the benefits that they have seen from the improved communication. We have also included a list of things that the checklist commonly catches:
- Anesthesiologist clarified that a generic drug name on medication list was a beta blocker, and nurse confirmed with patient that the medication had already been taken that day
- Type+screen would be needed prior to skin incision.
- Beta blocker had not been sent down for patient to take that day.
- Clarified and ordered antibiotic.
- Provided detail regarding procedure to be completed.
- Equipment needed and proper patient positioning during procedure.
- Identified need to do an unscheduled central line placement.
- Broken equipment was identified and fixed following the procedure.
- Applied SCDs due to extended length of case
- Missing equipment was identified at the beginning of the case.
Slide 30: Next Steps summarizes steps that you are taking to put the checklist into place. We have highlighted the items that are important to share with your colleagues.
Slide 31: Our Plan is a placeholder for you to summarize your roll-out plan. In particular the dates of when you are starting each service.
Slide 32: This slide summarizes what surgeons can do to help with this work.
Slide 32: Please insert the contact information for any questions that anybody might have about this project. It is extremely important for your colleagues to know who to contact for questions or concerns.