Experiences from Norway Barthold Vonen Nordland Hospital Trust
Overview Short background on Norway s work in JA PaSQ with regard to the checklist Experiences from Nordland Hospital Trust
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 2014 2009 2010 - the checklist (or adapted versions) was implemented in several hospitals around the country, Nordland Hospital Trust among others
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
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
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
Implementation of the Safe Surgery Checklist at Nordland Hospital Trust - turning a hospital crisis around Three locations Vesterålen Lofoten Bodø
SUMMER 2010
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
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)
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
Uke av02.01.2012 Uke av23.01.2012 Uke av13.02.2012 Uke av05.03.2012 Uke av26.03.2012 Uke av16.04.2012 Uke av07.05.2012 Uke av28.05.2012 Uke av18.06.2012 Uke av09.07.2012 Uke av30.07.2012 Uke av20.08.2012 Uke av10.09.2012 Uke av01.10.2012 Uke av22.10.2012 Uke av12.11.2012 Uke av03.12.2012 Uke av24.12.2012 Uke av14.01.2013 Uke av04.02.2013 Uke av25.02.2013 Uke av18.03.2013 Uke av08.04.2013 Uke av29.04.2013 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 av06.01.2014 Uke av27.01.2014 Uke av17.02.2014 Uke av10.03.2014 Proportions of operations using the Checklist February 2012 March 2014, Nordlandssykehuset HF 100 90 80 70 60 50 40 30 20 10 0 90 TREND
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
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
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
Has the implemetion of the Checklist reduced harm? Global Trigger Tool (GTT) analyses on 7 sites in the trust
Proportion of admissions with at least one adverse event across locations
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
Thank you for the attention!