Surgical checklists can saves lives, improve efficiencies and reduce costs. It is estimated that over 150,000 deaths a year in the US from surgery with as many as half of those avoidable. Surgery can be extremely complex often involving large teams. Checklists’ can help with memory recall and clearly set out minimum necessary steps within a process. Healthcare institutes have had varied success implementing. Some of the difficulties are cultural and some technical. In this article I would like to show how checklists can be implemented using Office 365. The article assumes a working knowledge of SharePoint Online. It is not meant to be a tutorial but an example of the possible. I’ve added links to more information throughout for those not familiar with the concepts.
We begin with an idea. The idea is adding a procedure, the checklist to surgery will reduce errors, length of hospital stays and costs. The checklist has a lifecycle, beginning with creation and ending with disposal. Additionally it needs to be categorized, managed and measured. This is true for any content we plan to add to a system. We must holistically approach the design so all aspects are considered. In this case content is a surgical checklist. Keep in mind content can be anything a web page, wiki, conversation, record in a list, multi media file. E=mail etc. Regardless of the type the planning is the same.
Figure 1 Content Lifecycle
Figure 1 is a simplified content lifecycle model. I will use this model to plan my checklist.
Create – creation is a key component in the user experience. We want an easy to use intuitive interface interactively guiding the creator through the process. In this example I’m using an InfoPath form. Yes, I know InfoPath has been deprecated but let’s not jump the gun. The current version will be supported through 2023 so I still have plenty of time. Coming soon is forms on SharePoint List or FOSL. FOSL will provide a uniformed inline form building experience across Office 365. It will also provide for modern device experiences further enhancing creation and consumption experience.
Approve – Approval can be passive I’ve saved or upload a document or it can be active I’m asking someone to review and approve. In this case we need someone to approve so I’ll be using a workflow created in SharePoint Designer. Workflow in SharePoint online is major upgrade from 2010. It is based upon windows workflow foundation and enables the creation of declarative workflows capable of solving real business problems. Click here for more information on workflow.
Discover – Discovery is where we often fall short. We create massive amounts of content but trying to find it can be a challenge. To simply discovery we will create an additional search vertical in the discovery center and add refiners to easily filter the information. We will also provide a simple and clean view in the list providing easy navigation. We will add item level security so a surgeon can only see their data.
Consume – Consumption is another key element in the user experience. How easily the information is discovered and presented are important components. We will accomplish this using the search vertical in search center, refiners, an Infopath form and a display template.
Dispose – Content is removed according to organizational policy. This will be accomplish by creating a management information policy along with the content type.
Manage – Management of the content exists through it lifecycle. Using out box the features like content type automates the management. The content type will also provide an easy way for categorization. The surgeon simply picks the content type “PreOperative Checklist” from a menu and the content will be categorized and managed throughout it’s lifecycle.
Measure – Measurement can take many forms. It could be how often something is consumed, whether is liked or how it has been rated. In our example measurement will be comparing the results of patient’s outcomes prior to checklist being initiated to those after. We expect positive results in lower costs and less complications. If we do not receive the expected results we will investigate our process looking for flaws.
Figure 2 Site Hosting Checklist Solution
Figure 2 is an example of a SharePoint Online site hosting our solution. There are 4 components.
1. A menu to navigate the site. It is 3 tiles.
a. Create – Select this option to create a checklist
b. Search – Select this option to search for a checklist
c. Research – Displays a dashboard showing results of our study. Whether or not using these checklists reduce errors and if this reduction leads to shorter hospital stays which are less expensive.
2. On Call. Will show any checklist approvers who are on-call. If a question arises they can be easily contacted from this page using built in Lync integration
3. My Checklists – A list of my approved checklists in reverse chronologic order
4. Pending Checklists – Any checklist not yet approved.
The checklist I’ll use for this our example is the Preoperative Checklist from the Patient Safety Authority.
Figure 3 Preoperative Checklist from Patient Safety Authority
1. I’ll build this checklist using a SharePoint list. Figure 4 shows the fields and their type.
Figure 4 SharePoint List with fields representing checklist data
My first step is to create the site columns that will comprise the list.
2. Now, I’ll create a content type. The content type is a key building block. It will do much of the heavy lifting.
· Data is automatically categorized. This categorization can be used for discovery in our case navigation and search.
· Site columns create crawled properties. I can map these to managed properties and use as part of my discovery strategy.
· A template is assigned to the content type, the InfoPath form, controls the creation and consumption experiences.
· A workflow is used for approval. Once approved the workflow will declare the checklist a record and begin the disposal process.
· Auditing is enabled and allows us to measure and manage the content.
· A management information policy is applied. This policy is configured to delete the checklist after the required retention period is completed.
3. Apply the content type to my list and set versioning and item level permissions. Adding versioning gives me more control particularly if the form is lengthy and I don’t expect someone to finish it in one session.
Item level security ensures a surgeon will only see their data and reduces the clutter in the view making navigation easier.
Figure 5 Versioning Settings
Figure 6 Item level permission settings
Figure 7 InfoPath form used to create checklist
5. Create an approval workflow. This is done with SharePoint designer. This workflow will look up the appropriate approver and once approved create a record which begins the disposition process. The workflow has two parallel steps so if needed the creator can recall the checklist prior to approval
Figure 8 Approval Workflow
6. My content type contained site columns. These site columns automatically become crawled properties. I can map crawled properties to managed properties. This will allow me to use any of the site columns in my content as search refiners. In this example I am using doctor and procedure.
Figure 9 Mapping a managed property
7. Configure search. Search is highly flexible and easily configurable. In this example I decided to extend the default search center by adding a new search vertical “Checklists”. The search vertical is created using a result source. Result sources replace search scopes. They are essentially queries which allow you to organize content to be searched. I’ll also create a display template for the results. Display templates allow me to use html5 and java script to display the managed properties we previously created.
Figure 10 Search center with custom navigation and display template
8. Create a dashboard. The dashboard is created in Excel and displayed in SharePoint. I combine data sources to produce the charts. Dashboards can also be built with Power BI providing state of art business intelligence right within your portal.
Figure 11 Excel services dashboard
This solution provides an easy to configure checklist system which can be modified to meet various needs and requirements. It is one approach. Another would be creating an app. This would require programing skills. One great feature of the app model is the app store. It is possible someone has already created a solution that fits our needs. One example Form FrameWorX contains templates for medical checklists including;
· Basoor Heart Failure Checklist
· Basoor Heart Failure Readmission Prevention Checklist
· PQRI Diabetes Measures Form
Figure 12 App store search for forms