The Power of the Checklist: How to Create a Culture of Patient Safety at ASCs

Linda LansingSurgical Care Affiliates Senior Vice President of Clinical Services & Training Linda Lansing and Vice President of Clinical Services Michelle George gave a presentation titled "Implementing Safe Surgery Checklists at Your Surgery Center" on Oct. 1, 2013. The presentation touched on several important aspects of safe surgery checklists, including how to develop and successfully implement checklists at surgery centers.

"We use checklists every day just to get all the pieces of our lives accomplished in an orderly way," said Ms. Lansing. "Checklists are really memory aids and make sure we are able to get everything done we need to in a given day or period of time."

Ms. Lansing gave a brief overview of the history of the checklist—noting it's success in the aviation field and referencing The Checklist Manifesto by AtulGawande, MD—before moving on to discuss how safe surgery checklists prove effective in the literature.

"If you look at the literature, there are some interesting thoughts coming out about the usage of checklists, patient outcomes and communications and what the impact actually is on patient safety," said Ms. Lansing. "There is often higher compliance for things that are already established policy, but lower compliance when something new is added. That speaks to the culture of learning."

It takes time to change behavior, and significant behavior changes are driven by cultural changes, she said. The non-compliance is especially high when a new policy doesn't fit into the workflow process easily or takes a significant amount of time to complete. Studies show adoption and compliance rates are stronger among nurses than surgeons and anesthesiologists, and customization can make adoption easier.

Ms. George touched on several regulatory and accreditation requirements related to surgical checklists. The Centers for Medicare and Medicaid Services guidelines recommend the use safe surgery checklists as new regulations are rolled out.

"There is a lot of flexibility in what checklists can look like," said Ms. George. "There are a number of professional organizations that have developed and made recommendations on different checklists. We recommend centers also design checklists based on their unique settings."
Michelle George
The most successful centers design safe surgery checklists to address effective communication on safe surgery practices prior to administering anesthesia, prior to the incision and before the patient leaves the operating room. Accreditation agencies such as The Joint Commission and Accreditation Association for Ambulatory Health Care also require specific checklists present at the center.

To develop the checklists, Ms. George suggests administrators:

•    Engage actively with key stakeholders
•    Develop clear tools and processes to support implementation
•    Set clear expectations for individual accountability
•    Make the checklist part of your culture
•    Encourage team members to speak up if there are concerns

"Lack of engagement in the development and revision of the checklist is the number one reason why you have poor checklist pull through," said Ms. George. "Include all members of your team in the development and implementation process, and pay particular attention to physician influencers."

After developing the checklist, trial it in the surgical setting and make changes if necessary. The checklist should increase the detection of safety hazards, decrease surgical complication rate and increase communication between the OR team. When you are able to address why the checklist is necessary and how every provider can use it, the checklist will likely have higher compliance and a more positive impact on the center, said Ms. Lansing.

Download a PDF of the presentation.

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