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Three Principles for Safe Surgery: Marrying Process to Talent to Save Lives

December 17, 2015


We had 800 people registered for our webinar yesterday, The Role of Behaviors and Talent in Patient Safety and Organizational Culture. Hosted by Becker’s Hospital Review, it featured Michael Rose M.D., VP of Surgical Services for McLeod Health, Chairman of the South Carolina Safe Surgery 2015 leadership team, and named as one of the 50 experts leading the field of patient safety by Becker’s. He was joined by Ted Kinney, Ph.D, Vice President of Research and Development for PSI.

Dr. Rose is an expert in the successful implementationdescribe the image of surgical checklists. His experience and data show that they are ineffective unless they are part of an overall effort to create an “every patient, every time” culture. He cited scary statistics showing that in spite of years of concerted efforts, OR safety has not improved much. For instance, we still see 5-6 wrong site surgeries still occur every day. How important is this initiative in South Carolina?

“There are about 60 surgical programs across the state performing almost a million operations. That’s one operation for every 5 South Carolinians … and in our index year about 8,500 surgical inpatients never saw their loved ones again, and almost 300 outpatients having surgery never made it back home. If the safe surgical checklist could indeed reduce mortality by a third it would translate to many lives saved, along with morbidity and disability that might possibly be reduced.”

The results in South Carolina are impressive, indeed. Participating hospitals have seen saved lives, improved operating room efficiency and productivity. But success requires work across three equally important areas:

  1. Relationships – how the team interacts.
  2. Process – not just the checklist.
  3. The Caregiver Experience – everyone needs to own the process and the goals must be personal.

“Our aim was performance and outcomes, and we thought it was all about methods and technology…but it really became a story about people … the human element … behavior and relationships. It is a story that has as much to do with making our teams able to work smarter, as it does with our teams getting healthier.”

The challenge was getting everyone on the OR team: Surgeon, Anesthesiologist, Nurses and Techs, to “own” the process and take personal responsibility for each case. It meant getting people from a “Have to” attitude to a “Want to” attitude.

Processes, themselves, can help to change behaviors. It’s more than plugging in a checklist. For instance, the teams were required to debrief every case and expected to point out ANYTHING that could have been improved. These behaviors are part of the performance management criterion for everyone in the room – including physicians.

But – as Dr. Kinney pointed out, some people are more willing, and able, to move from “have to” to “want to”. The best processes in the world will be ineffective if the people making up the OR team simply don’t have the collaboration, internal locus of control, attention to detail and accountability genes, so to speak.

Culture is nothing more than the accumulative behaviors of the team or organization. Culture is not a program or a set of principles, but how everyone in the organization, and hence, the organization thinks about and attacks, challenges. When you can marry great process, with leadership commitment and the right talent strategies – both on the selection and development side, great things can happen!

To learn more about this topic, download our Whitepaper:

healthcare talent strategies



Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.