Community Health Systems (CHS), a Tennessee-based hospital organization that owns 158 hospitals in 22 states, has long used safety checklists in its operating rooms. Since 2004, their Universal Protocol has served that role, offering a series of prescribed elements and standardizing time-outs and site marking. And while they had some success with that approach, the rigidity and lack of collaboration with that approach clearly fell short of their goals.
“You could be reading your grocery list and nobody would notice,” says Pat Turner, Senior Director Surgical Services at CHS. “It was such a rigid process [before]. We were stopping and pausing, but they certainly weren’t engaged.”
Then Turner attended a meeting at the South Carolina Hospital Association in 2013 where she was asked to be on the steering committee for the surgical safety checklist in development as part of the Safe Surgery 2015: South Carolina initiative. She noticed how much emphasis was given to having a discussion that incorporated all the team members that was less of a series of items to be checked off and more of a chance to develop the necessary rapport to work together on complex tasks.
“They were having a conversation about the patient and the procedure,” she points out. “It helped ensure the engagement of all team members in keeping the patient safe.”
The experience inspired Turner to revisit CHS’s system-wide checklists. That summer she convened all the directors from the system’s SC hospitals to improve the checklist process.
“[We] used the Safe Surgery 2015 checklist as well as the WHO checklist and came up with our own variation. We put that in use in the fall of 2013 in our hospitals,” says Turner. “Everyone in South Carolina was already using their checklist, so that was helpful in getting ours implemented.”
Turner made sure to bring in staff from around the hospital, not just in surgery, to ensure that the checklist was robust. Consultants from radiology, obstetrics and the catheterization lab all weighed in, making suggestions and tweaking the process over the course of a few months before CHS began implementing it in January 2014. That April, Turner proudly returned to SCHA with her new checklist, where she met Dr. Atul Gawande and Dr. William Barry, key figures behind the Safe Surgery Saves Lives Study Group at the Harvard School of Medicine.
“I asked them questions about barriers to implementation,” she recalls. “Dr. Atul came to see me after that meeting and asked if we would be willing to partner with them in the Harvard research. They hadn’t been able to get a large group across the country to partner with them.”
CHS, which had more than 200 hospitals across 23 states at the time, fit the bill. Turner jumped at the opportunity.
The system’s results with the new checklist have been incredibly compelling—they’ve seen almost a 75% reduction of serious safety events in their hospitals. CHS continues to learn more about their process and still works with the Harvard research group, but Turner credits SCHA for providing the inspiration for their transformation.
“It all came from the South Carolina Hospital Association,” she says. “As I go around the country to meet other people and talk about this, they are always impressed that I’ve worked with SCHA.”