MOC ‘n Cheese: Claim credits by applying the Swiss cheese model to your practice
By Sylvain Boet, MD, PhD, CPD Program Participant
Soft, non-technical skills like communication, situational awareness and teamwork can have a huge effect on patient safety. Why not develop your strengths in these areas with the help of the famous Swiss cheese model of accident causation?
I work as an anesthesiologist at The Ottawa Hospital. For the past decade, I have studied the impact of non-technical skills on performance in acute care. I’ve learned that it’s almost always a series of events — not any single event — that leads to risky situations or complications during surgery. This is also the premise of Dante Orlandella and James T. Reason’s Swiss cheese model.
I’m going to show you how to use this model in your own practice to improve your non-technical skills, enhance patient safety and claim MOC credits!
How to apply the Swiss cheese model to your work
Make a list of your practice’s top risk factors
Practice situational awareness by making a list of the top factors you know can lead to risky situations — or worse, complications — in your own practice. For me, these include a favourable environment, such as the level of noise in the operating room (OR), making sure the equipment is ready, ensuring the team is on the same page by doing the surgical safety check, and having access to the surgeon before the operation. These are the safeguards in place for my patients and they represent the Swiss cheese slices in the model. What are yours?
Make simple adjustments to close these holes
When the holes (weaknesses or failure points) in the Swiss cheese model line up, your patient may fall through and experience harm. You can prevent this by marshalling your communications and teamwork skills to make simple and practical adjustments.
For example, closed loop communication is an extremely powerful technique for safe and effective communication.
Surgeon: “John, could you please administer two grams of cefazolin IV please?”
Anesthesiologist: “Two grams of cefazolin going in.”
Surgeon: “Thank you.”
Closed loop communication can be used for critical steps in the operating room. For example, surgical incisions, key medications or blood transfusions.
Another example is if I have judged that there is too much noise in the OR, I will ask if we can please turn the volume down. And if I know that my surgeon was on call last night and may be tired, I’ll be more attuned to pick up signs of fatigue.
Assess long-term behavioural and system changes that could enhance safety
After applying the Swiss cheese model to your practice, reflect on what you’ve learned and make systematic changes in your behaviour to improve patient outcomes. For example, it’s my routine practice every morning to take two minutes to speak with the surgeon. We review the day’s cases. I also ask how the surgeon is doing and I find out if they expect any technical issues with any of the patients. This routine has resulted in me being able to update a previous treatment plan and to provide the best possible pain relief options to our patients.
Finally, log your efforts for MOC credits!
Claim your learning as a Section 2 Personal Learning Project for two credits per hour.
Many preventable complications at the hospital involve poor team performance. Building your skills in situational awareness and using the Swiss cheese model to better understand your practice are excellent steps towards better patient outcomes. Also, as a bonus, you can claim Section 2 credits!