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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY January 2016 | Archived Issues

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Surgery Grand Rounds

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Education Schedule - January 2016 (PDF)  


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SCORE Marks Three Years of Changing Culture

SCORE team members discuss a project during rounds with Thomas M. Priselac, Cedars-Sinai president and CEO (right). Team members (from left) are Curtis Woodworth, RN, Andrew Kim, RN, and Julian Gold, MD.

For three years, teams across Cedars-Sinai have been engaging caregivers around the concept of SCORE, or "Safe Care in the O.R. Everytime." SCORE's unit-based interdisciplinary teams, led by surgeons, anesthesiologists, nurses and technicians in partnership with administrative leadership, are committed to emphasizing the importance of culture in relation to surgical quality and improvements in the patient safety process.

SCORE celebrated its third anniversary Jan. 13. At the main event, SCORE teams showcased their projects. An open house took place the same day.

Julian Gold, MD, co-chair of the Department of Anesthesia and a member of the SCORE leadership team, said SCORE is changing more than processes in the operating room.

"The underlying driver for this project is the fact that we want to change the O.R. culture," Gold said. "We really want the culture to be one where people feel comfortable speaking up about things they think are issues and getting constructive feedback from colleagues. Everyone in the O.R. should have a voice if they believe there are things that are not safe and should be done better."

Thomas D. Gordon, who recently retired as executive vice president of the Cedars-Sinai Medical Network, said he is seeing a change in culture thanks to the SCORE program.

"I actually believe it is starting to become a part of the everyday culture," Gordon said. "I think the program has been so successful — we've gotten to know the staff members, staff members have felt comfortable, docs have felt comfortable and I think that it has brought everyone closer together."

Juan Cobos, RN, 6OR's SCORE team lead, has been with Cedars-Sinai since 2009 and was part of SCORE when it began. The 6OR team has worked to develop more in-depth timeouts and has developed the OR Sweep, which removes all previous patient identifiers from the operating room, helping avoid a mislabeled specimen that could affect a patient's diagnosis.Surgical teams are not allowed to start opening for the next case until it is verified that nothing has been left behind.

In implementing projects like this, Cobos said, teams have to be aware of the barrier of complacency.

"You have to be motivated to try and overcome the attitude of 'This is how we've always done it,'" Cobos said. "That is one of the things that we encountered in the beginning. It's a big barrier, but we have to look at the greater good, and if it costs us a couple seconds to try something new, it's worth it for the patients."

Manisha Ati, RN, of the 8OR SCORE team said that working with the Performance Improvement Department's Lean Six Sigma management tools has helped 8OR succeed with projects such as the noise control effort Help Us Support Healing, and the team's current project, in which it is working to improve the use of intraoperative ultrasound.

"What I think is great about SCORE, especially with the Lean tools, is that it actually gives you a way to solve problems," Ati said. "We get so overwhelmed by this whole system we're caught up in, but it forces you to break it down on a micro level and say OK, we can't control what's above us, but we can control what's in front of us, so let's pinpoint certain issues, figure out how we can tackle it and actually fix it.

"That's what is wonderful about SCORE — it's tangible change, things you can have an impact on. I think that's wonderful, especially in the O.R. Now you have the tools and the means and the ways and the support to actually change something."

In its three years, the program has grown to affect many areas. Gordon, who has been involved with the SCORE team in the 310 Building, said there are many benefits to being part of the program.

"Staff members have the chance to meet senior management and develop a relationship with them," Gordon said. "I think senior management benefits by getting to know what the staff's needs and wants are; I think it breaks down all silos. Every one of my colleagues that I speak to is grateful that we get the chance to be involved and help. I look forward to the fact that senior management, staff and physicians get to work more closely together, and I think that is a privilege."

Gold hopes that as this program attracts new members and continues to grow, the idea of collaborative process improvement will become part of the everyday working environment.

"As Mr. Priselac says, 'Healthcare is a team sport,'" Gold said, referring to Thomas M. Priselac, Cedars-Sinai president and CEO. "At the end of the day, it really is all about the patient. The patient isn't focused on the quality of the work of a single individual, but it's really about how they feel at the end of it all, which is a reflection of the quality of the work of everybody who touches the patient."