Experiences from Norway. Barthold Vonen Nordland Hospital Trust

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Jared Pitts
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1 Experiences from Norway Barthold Vonen Nordland Hospital Trust

2 Overview Short background on Norway s work in JA PaSQ with regard to the checklist Experiences from Nordland Hospital Trust

3 Use of the WHO Safe Surgery Checklist in Norway December 2008 Western Norway regional hospital trust decided to test the WHO protoype surgical checklist 2009 Voss hospital started using the checklist followed by a systematic implementation project in all theaters in the 4 Hospital Trusts in the region Effect of the World Health Organization Checklist on patient Outcomes: A stepped wedge cluster randomized Trial. Haugen et al. Ann Surg May the checklist (or adapted versions) was implemented in several hospitals around the country, Nordland Hospital Trust among others

in the region Effect of the World Health Organization Checklist on patient Outcomes: A stepped wedge cluster randomized Trial. Haugen et al.

Use of the WHO Safe Surgery Checklist in Norway 2011 The Norwegian patient safety program In Safe Hands initiated Safe Surgery was one of 8 target areas Implementation/spread via the Breakthrough

4 Use of the WHO Safe Surgery Checklist in Norway 2011 The Norwegian patient safety program In Safe Hands initiated Safe Surgery was one of 8 target areas Implementation/spread via the Breakthrough Series/Model (IHI) 2012 Norway joined the Joint Action on Patient Safety and Quality of care and thus the Norwegian Knowledge Centre received financial support to implement the checklist in Norway through In Safe Hands However, the checklist was already in use and the campaign had further set focus on the checklist

Patient Safety and Quality of care and thus the Norwegian Knowledge Centre received financial support to implement the

5 Norwegian strategy and work JA PaSQ Autumn 2013: JA PaSQ implementation start (Baseline) Status in Norway Safe Surgery Checklist already implemented in several hospitals «Adjusted» aim to further support the implementation of the checklist in Norway Focus areas Correct use of the checklist, not only compliance Improvement model education of health care workers How Three whole-day workshops (October 2013, January and May 2014) Invited speakers, group discussions, sharing of experiences etc Who 7 hospitals participated (3 to 8 people from each hospital) Clinicians (surgeons, anaethetists, nurses), managers, quality managers etc

compliance Improvement model education of health care workers How Three whole-day workshops (October 2013, January and May 2014) Invited speakers, group

6 Future challenges in Norway - my personal opinion Lack of top level management desicions on using the checklist No concequences for not using the checklist No systematic documentation of use of the checklist in the patient notes Not systematic focus from governement health board on use of checklist when handling patient complaints A certain movement in some academic departments adressing use of the checklist as Desicion based evidence making

notes Not systematic focus from governement health board on use of checklist when handling patient complaints A

7 Implementation of the Safe Surgery Checklist at Nordland Hospital Trust - turning a hospital crisis around Three locations Vesterålen Lofoten Bodø

8 SUMMER 2010

9 Board meeting 16. sept 2010 Quote from the minutes: «The Board supports the proposed strategy on patient Safety and quality of care developed by the task group» «Ten initiatives will be implemented a. Docmap skal tas i bruk fullt ut som kvalitetssystem i NLSH b. Trygg Kirurgi sjekklisten skal innføres c. Det gjennomføres innledende undersøkelse av ansattes holdninger til pasientsikkerhet d. Det gjennomføres innledende undersøkelse av sykehusdødelighet e. Standardisert sykehus dødelighetsrate og skadefrekvens per 1000 liggedøgn monitoreres f. Det innføres pasientsikkerhetsvisitter g. Det innføres avdelingsvise/seksjonsvise kvalitetsparametre h. Det skal utvikles en pasientsikkerhets score for NLSH i. Det skal brukes tverrfaglige team for gjennomgang av diagnostikk og behandling av kreftpasienter j. Det skal etableres systematisk bruk av komplikasjonsmøter i kjernevirksomheten ved NLSH» Implementation of the Safe Surgery Checklist encouragement from the hospital management

Det gjennomføres innledende undersøkelse av sykehusdødelighet e. Standardisert sykehus dødelighetsrate og skadefrekvens per 1000 liggedøgn monitoreres f. Det innføres pasientsikkerhetsvisitter g.

10 Implemention First used October 2010 Today used at all surgical units at the hospital trust Goal achieved - 95% compliance (including acute operations) Main focus somewhat wider than the national patient safety campagin (i.e. not primarily prevention of surgical site infections)

operations) Main focus somewhat wider than the national patient

11 Usefullness beyond reduction in morbidity as perceived when introducing the list in 2010 Empowerment/accountability for other health workers than the doctors (surgeons, anaesthetists) Emphasise the role/presence of each member of the team Particpation and responsibility by the whole team

than the doctors (surgeons, anaesthetists) Emphasise the role/presence

12 Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Uke av Proportions of operations using the Checklist February 2012 March 2014, Nordlandssykehuset HF TREND

04.2013 Uke av20.05.2013 Uke av10.06.2013 Uke av01.07.2013 Uke av22.07.2013 Uke av12.08.2013 Uke av02.09.2013 Uke av23.09.2013 Uke av14.10.2013 Uke av04.11.2013 Uke av25.11.2013 Uke av16.12.2013 Uke av06.

13 Annual revisions in 2012 and 2013 Why revision? The implementation went quick and «easy» motivation was present A lot of external/internal focus in the initial phase, but what when focus is reduced? Where should the resources be allocated? Ownership to the tool Bottom up engagement

of external/internal focus in the initial phase, but what when focus

14 Is the Checklist read in detail? Status 2012 Bodø Vesterålen 7% 27% 73% Lest opp Lest, men omformulert 39% 54% Lest opp Tatt "på husk" Ikke besvart Lofoten 2% 14% 84% Lest opp Tatt "på husk" Ikke besvart

15 Is the Checklist read in detail? Status 2013 Bodø Vesterålen 19% 19% 81% LEST OPP OMFORMULERT 81% Lest opp Omformulert Lofoten 100% LEST OPP OMFORMULERT

16 Has the implemetion of the Checklist reduced harm? Global Trigger Tool (GTT) analyses on 7 sites in the trust

17 Proportion of admissions with at least one adverse event across locations

18 Thoughts regarding the quote from PaSQ: (from «Speakers briefing» for this webinar) Senior leaders who are hoping to effect organisation change should identify clinical leaders with credibility within hospital, high personal commitment to program, linkages to organizations administrative structure, and knowledge about the organizational culture Bradley et. al 2004: 1878, Stephanie Soo et al., Role of Champions in the implementation of patient safety practice change, Healthcare Quarterly Vol 12, Special Issue 2009

linkages to organizations administrative structure, and knowledge about the organizational culture Bradley et.

19 Thank you for the attention!

Online Supplement to Clinical Peer Review Programs Impact on Quality and Safety in U.S. Hospitals, by Marc T. Edwards, MD

Online Supplement to Clinical Peer Review Programs Impact on Quality and Safety in U.S. Hospitals, by Marc T. Edwards, MD Journal of Healthcare Management 58(5), September/October 2013 Tabulated Survey