CAT: Hospital Check Lists and TQM

"Surgery checklists save lives," reports The Washington Post (April 18, 2017). Hospitals in South Carolina that completed a statewide program to implement the WHO'sSurgical Safety Checklist had a22% reduction in post-surgical deaths. The study appeared in the August 2017 issue of Annals of Surgery. It is one of the first to show a large-scale impact of the checklist on the general population.

Surgical care requires careful coordination of various skilled healthcare providers in a complex infrastructure using specialized tools. "Safety checklists are not a piece of paper that somehow magically protect patients, but rather they are a tool to help change practice, to foster a specific type of behavior in communication, to change implicit communication to explicit to create a culture where speaking up is permitted and encouraged and to create an environment where information is shared between all members of the team," said the Harvard Medical School professor directing the study.

A total of 14 hospitalscompleted the program, representing 40% of the state's total inpatient surgery population. Researchers compared the 30-day post-surgery mortality resultsbetween the checklist hospitals with those of the state hospitals. The report includes significant inpatient surgical procedures from various specialties, such as neurological, cardiac, and orthopedic surgery.

The 19-item checklistencourages surgical teams to discussthe surgical plan, risks, and concerns. Most of the items are simple, such as "does the patient have a known allergy" or "is essential imaging displayed." Following surgery, patients are at risk of complications and death from various causes, such as infection and organ failure. The checklistends with a conversation requirement among the surgeon, anesthetist, and nurse about the patient's recovery and management plan. As a whole,the checklist items create an operating room communicationculture that improves overall surgical care and safety before, during, and after an operation.

1.What other tools could be used in operating rooms to improve quality?

2.Why are checklists so valuable?

3.What other industries use them regularly?