Webinar 14:Coaching in the OR Continued and

Speaking to Your Nursing and Surgical Tech Colleagues

Topics of Last Week’s Call• Coaching 101

– Purpose of coaching

– Choosing the right people to be coaches

– Providing feedback to surgical teams

• Checklist implementation and use best practices.

• Using the observation tools in the OR – A few reminders.

– Observers should take the online training

– The observation tools are designed to be used together in a surgical case.

How Did the Homework Go?

Last Weeks Homework• Continue/Start to administer the culture survey.

• Continue to talk with your colleagues one-on-one.

• If you haven’t already, hold the meeting that you scheduled at the beginning of the call-series with as many surgical personnel that can attend. This can be a large inter-disciplinary meeting or departmental meetings.

• Prioritize surgical specialties for the roll-out using your knowledge of which surgeons will be most receptive to the checklist.

• Create a timeline for your hospital’s expansion and send it to the Safe Surgery 2015 team at safesurgery2015@hsph.harvard.edu.

• Continue implementing the checklist.

• Use the Surgical Safety Checklist and Teamwork Observation Tools in one case.

Today’s Topics

• A coaching demonstration

• Talking to nurses and scrub techs: a mock presentation

• Listening

• Asking Questions

• Trying to improve people’s performance

What is Coaching?A Quick Review

• Telling

• Criticizing

• Instructing

What Coaching Isn’t

Ask Questions

• “I noticed that . . . can you help me understand?”

• “I saw that you . . . . . can you explain?”

• “I observed that you . . . . What could you have done differently?”

Who Makes a Good Coach?

• The best coaches are:

– coachable

– respected by their peers

– Understand how to give feedback

Show Me/Teach Me

Watch Me

Give Me Feedback

COACHING

Think About

• What you saw

• Who you are talking to

– Talk to the team

• What is going on in the OR

Your Observation

• What you saw– Be specific and clear

When You Give Feedback

• Keep it simple

• Keep it focused

• Be respectful

• Be kind

How would you have coached the team to remember the

Heparin?• Write it on a sticky note

• Use memory

• Write it on the white board

• Paging the surgeon right away

As the coach, what would your reaction be to the surgeon

saying, “Speak now or forever hold your peace?”

• It was okay for the surgeon to say that. I shouldn’t say anything.

• It is not okay for the surgeon to say that and I should talk to the surgeon about this now.

• It is not okay for the surgeon to say that and I will talk to him alone following this case.

1. How do you think the coach did? Give him a grade:– A = Excellent– B = Above average, but it could have been

improved– C = Average– D = Below Average– F = Poor

2. What would you have done differently, if anything?

Elizabeth Norton, BSN, RN, CNORLevel III Staff Nurse and Nurse for

Patient Safety and Quality in the ORChildren’s Hospital Boston

Talking to Your Nursing and Surgical Tech Colleagues

Could This Happen Here?

The Time Out• Time Out Led by circulator.• Circulator stated procedure as booked “Percutaneous

adductor tenotomy of the right and left groin”. • Team not actively listening or engaged but stated that they

agreed with Time Out. • Attending surgeon made incision and proceeded to open

and not do the procedure percutaneously as booked and as consented.

• Circulator observed large incision and questioned attending surgeon pointing out that the consent did not match the procedure.

More Facts• Attending surgeon stated that he had previously

talked to the family about the possibility of opening, but did not discuss with the team or write it on the consent.

• Circulator requested the consent to be corrected with the family and the consent was later amended.

• Team subsequently got into bleeding that required a general surgeon to assist with vascular repair.

What Could Have Helped?• If the surgeon led the time out and actively

participated.

• If a briefing was conducted where the operative plans and change in procedure would have been discussed.

We are very good at what we do….We can be even BETTER

How Can the Checklist Help Us Be Better?

• It makes sure that we do the things that our surgical patients need every time.

• It improves communication, teamwork and the culture of safety in our hospital.

• It can make surgical teams better prepared by reviewing necessary equipment and the operative plan.

Physician Acceptance and Leadership support is the

Critical Factor in Successful and Meaningful Use of the

Checklist

How Do We Feel in the OR as Nurses

• Before going into the OR I need to prepare my approach depending on surgeon or team.

• I know when there will be a battle and I need to prepare my response.

• Try to be positive during the surgical case, no matter what happens.• Nursing carries the load to ensure that the safety checks are

completed.• I don’t want to be the enforcer but sometimes need to be for patient

safety. • I am not the right person to convince a surgeon who refuses to do

this.• Some frustration when team is not open and I feel shut down.

How Do We Feel in the OR as Scrub Techs

• I am part of the team and am responsible for patient safety as much as everyone else.

• I don’t want to waste time fighting about this- I wish we could just do it!

• Ready to change my approach, depending on who I am working with in the OR.

• The majority of the team will listen and participate, but I may need to help remind the surgeons to follow policies.

• Willing to back up circulator and to take on equal responsibility to ensure that this is completed for my patient.

• I think that it is the right thing to do.• If I were the patient I would want it done for me.

We Can Make a Difference

• It is important to work as a team to improve the safety and outcomes of our patients.

• We are not powerless to make change.

• We are part of a surgical team and often in the position of leading that team – that is a privilege and an opportunity to make a difference.

Your Role In This

• You have the power to initiate and lead the checklist, if needed.

• Speak up when information is not shared or if you have questions.

• Become a leader in the OR when other team members do not.

• Engage the attending surgeon to brief about the patient and the surgical procedure with the team.

• Initiate introductions.

• Set a professional tone.

• Encourage team members to speak up.

• Encourage the team to debrief before the patient leaves the OR.

What is This Really About?

• This isn’t just about you as an individual and what you need.

• Everyone is in the room for the patient and all of the people around you need your help, encouragement and leadership.

• Surgery is a team effort and the most effective and safe surgical teams recognize that.

This is About Teamwork

• Communication

• Coordination

• Team performance valued over individual performance

• Leadership

Observation Tools

• We have made some minor modifications to the tools and the online training.

• Both observation tools should be used together in a given case.

This Week’s Homework• Continue to implement the checklist.

• Continue to perform observations using the tools provided to you. At a minimum, hospitals should complete five observations using both tools. If you are part of the research please send the completed observations to:

Lizzie Edmondson

Harvard School of Public Health

Department of Health Policy and Management, 4th Floor

Boston, MA 02115

Email: ledmondson@partners.org

Announcements

• The deadline for submitting a video for the competition is August 15th, 2011.

• The webinar on Tuesday, August 9th will be cancelled.

• Office hours on Friday, August 12th will be cancelled.

??Questions

Ask Us a Question By Using the Raise Hand Button

Office Hours:

Friday 12:00-1:00

Next Week’s Call is Cancelled

Resources

Website:www.safesurgery2015.org

Email: safesurgery2015@hsph.harvard.edu