Sustainability and the Premortem Tool: Slide Presentation

Slide 1: AHRQ Safety Program for Surgery—Sustainability

Sustainability and the Premortem Tool

Slide 2: Learning Objectives

After this session, you will be able to–

• List benefits of a premortem exercise from the sustainability perspective.
• Use the Comprehensive Unit-based Safety Program (CUSP) Premortem Tool to identify risks to sustaining your efforts.

Slide 3: Problem Statement

• Projects fail for many reasons.
• This project is no exception.
• Recognize potential barriers and complications to aid project implementation.
• Anticipate problems to help teams sustain improvements.

Slide 4: Preparing To Lead¹

• In a postmortem, an autopsy is performed to learn why a patient died.
• While it may be helpful, it does not help the central figure in the medical drama—the patient.

Image: Illustration of a foot with a toe tag.

Slide 5: Preparing To Lead

The Premortem Exercise helps you–

• Imagine the project has failed.
• Brainstorm contributing factors that led to this failure.
• Develop plans to mitigate these barriers to sustaining success.

Slide 6: Preparing To Lead

• Identify potential barriers and vulnerabilities.
• Build intuition and sensitivity to future problems.
• Encourage team members to speak up during planning stages.
• Prepare proactive approach to address concerns.

Slide 7: Premortem Exercise

Step 1

• Imagine that you are 2 years into the future, and despite all of the team’s efforts, the surgical safety program has failed—catastrophically.
• Many things have gone completely wrong.
• Ask your team:
  • What does the worst-case scenario look like for you and your patients?

Slide 8: Premortem Exercise

Step 2

• Generate the reasons for this failure to sustain improvements.
• Spend 10 minutes recording the reasons that could cause this failure.
• Ask your team:
  • What could have caused our project to fail?

Slide 9: Premortem Exercise

Step 3

• Identify the level of concern for each reason.
• Use a scale of 1 to 5.

Image: Level of concern (Likert scale) uses a scale of 1 to 5 where Lowest (1), Moderate (3), and Highest (5).

Slide 10: Premortem Exercise

Step 4

• Prioritize your list of potential reasons for failure.
• Address the top two or three concerns.
• Ask your team:
  • What specific actions can you take to avoid or manage these concerns?

Slide 11: CUSP Premortem Summary

1. Two years out, what does the worst-case scenario look like?
2. What could have caused your project to fail?
3. What specific actions can you take to avoid or manage these issues?

Slide 12: Discussion

• Set goals for sustainment—what do you want to maintain?
• Target the potential risks for failure to achieve sustainment goals.
• Remember that sustainability is a process, not a project.

Slide 13: Discussion Questions

1. What aspects of the project are you planning on sustaining and how?
2. What challenges do you predict for sustaining progress?
3. How will you address these challenges?

Slide 14: References

1. Klein G. Performing a Project Premortem. Harvard Business Review. Sept 2007. https://hbr.org/2007/09/performing-a-project-premortem. Accessed Aug 22, 2015.