WHO Checklist Its Value & Limitations e: academy@yhahsn.nhs.uk/ - - PowerPoint PPT Presentation

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WHO Checklist Its Value & Limitations e: academy@yhahsn.nhs.uk/ - - PowerPoint PPT Presentation

Oct 26, 2023 257 likes •593 views

Part of the Yorkshire & Humber AHSN WHO Checklist Its Value & Limitations e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House /

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SLIDE 1

Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

WHO Checklist

Its Value & Limitations

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshi kshire e & Humber ber AHSN

  • History & Rationale
  • Successes
  • Limitations
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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

History

  • Pronovost (2001) introduced a short checklist for health-care workers who insert

central lines. Asking practitioners to confirm that they had performed certain simple actions, such as washing their hands and sterilizing the insertion site, contributed to a dramatic reduction in the risk of life-threatening infections.

  • Keystone ICU project, Michigan (2003) Within 18 months of checklist introduction

the rate of catheter-related bloodstream infections fell by 66%.

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • ‘Matching Michigan’ 200 ICU Units in the UK 2009 – 2011
  • Initial analysis of results published in 2012 – suggested similar reductions in

mortality as seen in the US

  • Later analyses highlighted that it was not possible to separate the effect observed

during checklist implementation from pre-existing downward trends in infection- related mortality.

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • 2007 and 2008, eight hospitals around the world tested the checklist in a pilot

study..

  • Complications such as infections after surgery fell by more than one-third, and

death rates dropped by almost half.

  • The WHO recommended that all hospitals adopt the checklist or something similar.
  • NHS immediately required all of its treatment centres to put the checklist into daily

practice .

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Results have not been widely replicable…

  • An analysis of more than 200,000 procedures at 101 hospitals in Ontario, Canada,

for example, found no significant reductions in complications or deaths

  • Systematic review of implementation - 11 out of 22 studies didn’t even include their

‘health’ outcome data.

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

How do the Airline Industry use checklists?

  • Checklists are far simpler
  • Not necessarily designed to stimulate discussion
  • Team training + complex redesign of processes and work environments +

checklists = incident reduction

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • Where the conditions allow them to be used in a simple way – they work well.
  • A checklist will support a well-defined procedural task that may be vulnerable to

problems with memory, task omissions or order.

  • Checklists may help teams with a good but not outstanding team interaction to

improve their internal dynamics.

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Example of systems engineering alongside implementation…

  • “we identified one exemplary ICU, in which a high infection rate fell to zero after

Matching Michigan began. The unit was led by a charismatic physician who championed the checklist and rallied others around it. He formed coalitions with his colleagues so everyone was singing the same tune, and they just committed as a whole unit to getting this problem under control”

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

www.improvementacademy.org

Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • NATSSIPS – extension of the checklist principle to wider

systemic issues such as staffing, skills mix, patient flow etc.

  • Do we have evidence that checklists can tackle such issues?
  • What type of training needs to be provided alongside?
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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Can a Theoretical Approach help?

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  • Complexity Science
  • Management Studies
  • Clinical studies
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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

What is the purpose of checklists?

To help us deal with Complexity

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Snowden (2008)

  • 4 key domains which describe the way in which human social

structures organize themselves

  • Different domains require different approaches to management

Checklists through the lens of Complexity Science

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‘Linear’

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‘Complicated’

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‘Complex’

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‘Chaos’

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How can leaders start to manage Complexity?

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • Decentralistaion of power
  • Shift in team structures from ‘Hierarchy’ to ‘Heterarchy’
  • Empowerment of team members
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In theatres…

  • The environment is so complex that no individual can maintain a

constant awareness of all the factors relevant to patient safety

  • Staff need to be empowered to act as a ‘Sensor Network’
  • Open communication is a key determinant of ‘Resilience’
  • Hierarchies and power gradients can inhibit the flow of information
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Edmondson (2000)

  • 1. Communicated a compelling reason to ‘speak-up’
  • 2. Downplayed the power differences between themselves and
  • ther team members
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Communicating a compelling reason to speak up….

  • Relentlessly emphasise that patient safety in the primary and

non-negotiable aim of the team

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Downplaying power differences….

  • Use first names
  • Clarify and acknowledge the importance of each team member role
  • Express to the team that successful outcomes are due to the synergistic

combination of their skills

  • Explicitly invite input regarding patient safety
  • Visibly act on useful input
  • Adopt a complex view of error
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SLIDE 28

Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Once, during a heart bypass, a theatre Nurse dropped a vein graft on the floor. She spoke up and the surgeon didn't say a word. He just made another incision. Maybe a millisecond was lost before starting to harvest another vein. No yelling or screaming. He didn't need to. She knew she’d made a mistake.

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Complexity Leadership

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Never Events Taskforce

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  • Envisaging theatre environments as complex social systems can help

leaders to understand how hierarchies and power imbalances within theatre teams can hinder the flow of important information and compromise patient safety

  • A key set of coaching behaviours can help leaders create the conditions

for ‘speaking up’

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Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926

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Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

  • Is the view from complexity intuitive / useful?
  • Could the coaching behaviors form the basis of leadership

training (based on behavioral change methods ) to create the preconditions where successful checklist implementation can

  • ccur?