A deceptively simple tool is making surgeries safer in a growing number of Saskatchewan operating rooms.

Health regions are working toward universal implementation of surgical safety checklists, and one of the tool's Saskatchewan pioneers is marvelling at the difference it has made in her own practice.

"Imagine going to the grocery store with a list of 10 items in your head," said Dr. Corrine Jabs, a gynecologist with the Regina-Qu'Appelle Health Region, at a recent media conference. "You might forget one of them once in a while."

The same thing can happen in the operating room, Jabs said, when surgeons, nurses, and anaesthetists depend solely on their experience and memory before, during, and after surgeries.

While there are enough checks and balances during most surgeries to keep patients' risks very low, standardized checklists have been shown around the world to reduce those risks still further. Surgical team members verbally confirm information such as the patient's identity, the procedure being performed, surgical equipment required, and potential complications arising from the patient's health history or condition. Following surgery, they confirm instrument counts and review any issues encountered during the surgery.

Health Minister Don McMorris said this is another way to ensure the health system puts patients first. "Health and safety risks are usually very low for Saskatchewan surgical patients, and surgical care providers already do routine checks to minimize risks," McMorris said. "However, we know those risks can be reduced even further through consistent use of practices that are proven to increase patient safety. The checklist should be used by every surgeon, for every patient, every time."

Regina Qu'Appelle Health Region was one of the first health organizations in Canada to adopt the surgical safety checklist. It was first used in 2009 by Dr. Jabs and has since been adopted by other surgical specialties in the region.

As pleased as she is by the checklist's potential to improve patient safety, Jabs is even more excited about how the new practice has enhanced teamwork in the hospital and operating room.

"The most important thing is, it's a communications tool," Jabs said, noting that the process ensures surgical team members are talking to each other about patients and their needs.

"They feel comfortable in knowing what they need to do, and they know it's okay to ask questions, to clarify things," she said. "It changes the atmosphere in the room."

By the end of 2010-11, the checklist will be standard procedure in all hospital operating rooms in Saskatchewan.

Dr. Peter Barrett is a Saskatoon-based urologist who recently agreed to serve as a physician leader with the Saskatchewan Surgical Initiative. We asked him to share some of his thoughts about the work being undertaken to transform surgical care in Saskatchewan.

Q: You have a very busy practice. What prompted you to take on this role with the Saskatchewan Surgical Initiative?

A: I was moved by the Patient First Review, which reflected the sort of feedback I get regularly from family members, friends, and patients. Frankly, the healthcare system has become focused on providers and the system itself and is not very patient-friendly. Silos and poor integration abound, and too often patients are forced to navigate through a complex system.

I also feel that there is waste in the system because of poor quality control and safety issues. If these were addressed, we'd get better value for our money and the system would be sustainable.

Yes, I am busy, but if I'm to be credible in a surgical leadership role, I think I have to be in the OR and experiencing the day-to-day issues the people I'm trying to motivate live with. You've got to walk the talk.

Q: Maximum wait times of three months, within four years? Can it be done?

A: Yes, it can be done. The Saskatchewan Surgical Care Network has already got the data that shows that we don't need that much more OR time to accomplish it. The real issue will be those surgeons whose wait lists have reached the point where even if we offered them operating time 24 hours a day for the rest of their lives, they couldn't get them all done. We'll need to offer those patients the opportunity to see someone else.

Q: You've emphasized a number of times that 'safer and smarter' surgeries are as important as 'sooner' surgeries. Can you elaborate on that?

A: The public assumes the quality is good and the system is safe. When you fly, it's a given that the pilot knows what he's doing and the plane is safe. But until we start measuring it and reporting it publicly, how do you know? When I was chief of staff, I noted at the board meetings that the board fussed about the financial report but accepted the CEO's and chief of staff's assurance that the quality was good and the hospital was safe. We weren't in the financial business, we were in the healthcare business, but you could measure the former and we had no data on the latter. We need to start measuring and reporting if we are to have good governance. We also want to reduce practice variations among specialists and improve accountability.

Q: What kinds of things are you doing in your practice to create a more patient-and-family-centred care approach?

A: We've gone to a pooled referral system where patients are automatically directed to the urologist with the next available appointment who has expertise in the area required. We haven't taken away choice; patients can see any urologist they want, as long as they understand they may be choosing to wait longer.

We've also redesigned our practice to match our supply to our demand, and then we donated a week of our holidays to work down the backlog that had accumulated over the years. We have attempted to maximize the value of that initial consult by making sure the necessary tests and information are available to make a decision at that visit and reduce the need for subsequent visits. We've also been working on care pathways to give the patient and family physician so that they don't need to see us again unless certain trigger points occur.

Q: How do you view your role as a physician leader for this initiative?

A: I see my role as a motivator for change. The healthcare system won't get better unless we engage physicians and other frontline providers and convince them to change. Government can't impose it and the public isn't to the point where they're going to go nuts, so the only way I see change happening is from within. We have good alignment on the vision among those leading this initiative. This includes the unions and provider groups as well as the Ministry, health regions, Health Quality Council, and patients. This is truly unique to Saskatchewan. If we can't do it here now, we never will. It can be done.

Surgical care in Saskatchewan took a significant patient-centred step on June 7 when Health Minister Don McMorris unveiled an online "Specialist Directory".

Anyone with an Internet connection can access the directory, which contains a wealth of information about the province's surgical specialists, the procedures they perform, and average wait times for those procedures. Equipped with that information, potential surgical patients can work with their family physicians to find a specialist option that best suits their needs.

Doug Denk, a patient advisor with the Saskatchewan Surgical Initiative, participated in the June 7 news event with Dr. Phillip Fourie, a Yorkton family-practice physician and vice-president of the Saskatchewan Medical Association.

Since then, Denk says, friends and family members have been contacting him to rave about how valuable the directory's information will be for them.

"It's so important that all of the specialists get on board," Denk said. "This is a great tool for putting the patients first."

"The Specialist Directory makes it much easier to find an appropriate surgeon to refer patients to," Dr.  Fourie said. "Patients are leaving my office knowing how long they can expect to wait for their consult, which is very reassuring."

The Specialist Directory is located at www.health.gov.sk.ca/specialist-directory . It will eventually include information about non-surgical specialists in the province. The directory draws its wait time information from the Saskatchewan Surgical Registry, which tracks all surgeries performed in hospital operating rooms in the province.

Surgical wait times have been significantly reduced over the past two years.  From March 31, 2008 to March 31, 2010, the number of people waiting more than 18 months for surgery has been reduced by 39 per cent, from 2,568 to 1,560. The number of people waiting more than 12 months was reduced by 22 per cent, from 5,137 to 4,002.

Click here for the news release, or click here for quarterly wait time information.

Are you and your colleagues doing something to transform surgical care in Saskatchewan? Please contact us with your story. No information will be published without your clear and informed consent. Send a note with your contact information to info@gryphonrm.com. We want to hear from you!

Sooner, Safer, Smarter is published by the Saskatchewan Ministry of Health in support of the Saskatchewan Surgical Initiative and patient- and family-centred health care.