Management Practices for Sustainability Module 4: Observation and Integration

Slide 1: Management Practices for Sustainability Module 4: Observation and Integration

Management Practices for Sustainability

Module 4: Observation and Integration

Slide 2: A Frontline Management System To Promote Safety Standard Work

Image: This image shows the interactions between the different elements of the frontline management system.  The elements include standard safety work by staff, the daily safety huddle, visual management, escalation, observation of safety work, problem solving, and integration with leaders.  The image shows how these elements are mutually reenforcing to effect sustained improvement.

*Quality improvement

Slide 3: Benefits of Direct, Regular Observation: Surgical Safety Checklist Usage

1. Direct evidence of how well people are able to use your center's surgical safety checklist 
2. Basis for coaching individuals or specific teams
3. A way to identify training needs
4. Data to reveal patterns and track performance over time
5. Foundation of “integration”– standard work and alignment across organizational levels

Slide 4: Example of a Data Sheet Used To Guide an Observation

Image: Example of Observation Form - This table shows a sample form for frontline managers to observe the surgical checkout, highlighting the elements recommended by AHRQ's Safety Program for Ambulatory Surgery.

Key:

ID:  Identity
DOB:  Date of birth
CRNA: Certified registered nurse anesthetist
IVATB: Intravenous antibiotics
MD: Doctor of medicine
RN: Registered nurse
ST: Surgery tech

Slide 5: Example of a Data Sheet Used To Guide an Observation–2

Image: This figure shows how a manager can track fidelity to standard work over time. It shows a number of elements in the management system, such as huddles and visual management, and includes check boxes for each day of the week.

Key:

BO: Business Office
Pre: Preop unit
OR: Operating room unit
SPD: Sterile processing department
PAC: Postacute care unit 

Slide 6: Apply the Model for Improvement to Observation

• What are you trying to accomplish? Reliable use of agreed-to work methods (e.g. surgical safety checklist and communication behaviors)
• How will you know that a change is an improvement? Better alignment between agreement and actual practice shown in surgical safety checklist record
• What can you change to make an improvement? Use regular, direct observation by the unit supervisor

Slide 7: Apply the Model for Improvement to Observation–2

• Plan: Lay out the specifications of your test
• Do: Conduct the test
• Study: Review how the test went and lessons learned
• Act: Integrate your learning into your next test or into daily practice

Image: PDSA Ramp - This figure illustrates the often iterative nature of PDSA cycles-- changes that result in real improvement usually require a number of tries and modifications.

Slide 8: Apply the Model for Improvement to Observation–3

Slide 9: Tips

1. Use direct observation to help you understand differences between teams, surgeons, and procedures.
2. Direct observation helps the supervisor see problems (undesired gaps between intention and actual practice).  
3. Supervisor can report on gaps in daily huddle and use problem-solving methods to reduce the gaps.
4. The surgical safety checklist observation form is a natural addition to your visual management board.
5. The AHRQ Safety Program for Ambulatory Surgery has great resources on coaching.

Slide 10: Observation and Integration

1. Use observation of standard work as the raw data for next-level leader standard work.
2. Consider huddle only for unit leaders to discuss problems touching multiple parts of the facility (e.g., sterilization, scheduling).  
3. Expand observation beyond the surgical safety checklist to multiple types of standard work, such as sterilization, or handoffs.
4. Remember to report progress to leaders such as the medical directors and ambulatory surgery center board to ensure continuous buy-in and help remove barriers to progress.