Rapid Evaluation Approaches for Complex Initiatives : Table 1


: Table 1

Evaluation FactorProcess ChangeWorld Health Organization’s Safe Surgery Checklist
1.     Situational dynamicsSimpleThe team’s dynamics are simple; the surgeon leads the surgical team. In surgery, the patient’s unstable health adds some complexity to the situation.
2.     Intervention complexitySimple projectsSimple project: the surgical team completes a two-minute, 19-step checklist designed to prepare teams better for surgery and to respond better to unexpected problems that occur during surgery.
3.     Governance structureOrganizational unitHospital operating room teams implement the checklist.
4.     Scale of outcomesSingle, discrete process changesThe checklist changes the quality of the procedures used to prepare the patient and the surgical equipment before surgery and to prepare the team for potential problems during the operation.
5.     Timeline of expected resultsImmediate change expected within weeksThe checklist was introduced to operating rooms over a period of one week to one month. Data collection started during the first week of checklist use.
6.     Theory of changeImplementing an evidence-based practiceThe same procedure was used in all situations, with minor adaptations in language, terminology, and the order of the checklist items for different hospitals.
7.     Execution strategyFidelity to a set of documented proceduresHospital surgical teams received the checklist with a set of how-to PowerPoint slides and YouTube videos.
8.     PurposeImplementation, efficacy, and outcome questionsThe eight-hospital pilot study tested the checklist’s efficacy; major complications were reduced by 36 percent and deaths were reduced by 46 percent after the introduction of the checklist.
9.     Reporting and use of findingsUnit operations managers and staff receive and use evaluation resultsTo create the prototype of the checklist, Gawande’s surgical team tested multiple versions of the original checklist using operation process and outcome data, and team feedback, to track improvement of the checklist.
10.  Rapid evaluation methodsQuality improvement—PDSA cycleThe team developing the checklist used the results of each PDSA cycle to improve the checklist, so that it was ready to be tested in operating rooms in other hospitals.