Ideas That Work: Nightmare Scenarios

Before critical procedures like our high-volume thyroidectomies, we gather a multidisciplinary team to play a game of "What Could Go Wrong?" in which we discuss what we'd do if worst case scenarios ever came to pass. We set a time limit of 20 minutes for generating potential "failure modes" — what we call anything and everything that could go wrong, from receiving an incomplete patient history to unexpected complications with the surgery — from each staff member. We rate these scenarios a on a scale of 1 to 10, with 1 being something that's "very unlikely to occur" and 10 being something that's "very likely to occur."

If you want to incorporate What-Could-Go-Wrong brainstorming sessions at your facility, here are a few ground rules you should follow:

• Stress to your staff that there's no such thing as a bad idea as long as the idea is relevant to the topic at hand. You don't want people to be afraid to speak up!
• Shoot for quantity, not quality, early on. The more ideas, the better. You want staff to piggyback off each other in the initial brainstorming session.
• "Remind staff to think about all the different areas where a failure could occur — people, supplies, equipment, methods and environment.

Suzi Walton, CASC
Ohio Surgery Center
Columbus, Ohio
[email protected]