The [Insert Hospital/Hospital System Name Here] Experience

1. The[Insert Hospital/Hospital System Name Here]Experience [Insert Name of Program Coordinator Here] [Title of Program Coordinator] [Name of Hospital] **Template Presentation Developed with Florida Hospital Heartland Division as part of the Adventist Health System Experience.**

2. CLABSI Success Summary • Since [Year], central line-associated bloodstream infections have been reduced in the [name units] at [hospital name] by [xx percent]. • Since [Year], approximately [xx] lives have been saved, and [$xxxxx] in excess costs have been saved.

3. [Insert Logo/Name of Hospital Here] • [Insert picture here to illustrate figures to the left] [###] Acute Care Bed [###] Long Term Care Beds [###] Admissions [###] ED Visits [###] Home Health Visits [###] Outpatient Visits [###] Nursing Home Patients

4. [Insert Hospital/Hospital System Name/Logo Here] • Net Revenue [$#######] • Net Earnings [$#######] • Community Benefit [$######] • Medicaid Unreimbursed Cost [$#######] • Medicare Unreimbursed Cost [$######] • Community Health and Wellness [$#####] • Faith-based and Spiritual Health [$#####] • Capital Improvements to Infrastructure [$######]

5. [Insert Hospital/Hospital System Name/Logo Here] • [Insert bullets outlining any awards and/or recognitions that you may have a received as a result of your participation in CUSP] • [Awards] • [Recognitions]

6. CUSP (n): • a point of transition • a fixed point on a mathematical curve at which a point tracing the curve would exactly reverse its direction of motion • a point on the grinding surface of a tooth • an ornamental pointed projection formed by or arising from the intersection of two arcs or foils

7. CUSP Framework • Evaluate Culture • Train staff in the science of safety 3. Engage staff to identify defect 4. Senior executive partnership/safety rounds 5. Continue to learn from defects 6. Implement tools for improvement 7. Re-evaluate Culture

8. Objectives • To understand the benefit of including change management theory within the performance improvement methodology • To understand the three key components of effective change management

9. Traditional Improvement Methods • Joint Commission Ten Step Model • Plan-Test-Act-Check • Shewhart Cycle – PDCA • HCA Focus-PDCA • Six Sigma – DMAIC • Xerox Ten Step Benchmarking • Toyota Production System • Baldridge • ISO9000 • Scientific Method • Rapid Cycle Improvement • Decision Making Cycle • E&Y Seven Step IMPROVE Process • Organizational Dynamics FADE Cycle • AHIMA Process Improvement Cycle • Planned • Systematic • Organization-wide • Collaborative • Prioritized • Data driven • Action oriented

10. Cultural Assessment Results • Insert a chart/figure illustrating the results of the cultural assessment/safety attitudes questionnaire.

11. Insert another figure/chart/graph illustrating cultural assessment results. • Tip: Make this figure/chart/graph compare each of the units within your organization. • Insert another figure/chart/graph illustrating cultural assessment results. • Tip: Display a figure that would compare your organization against others.

12. Change Management Theory • Below are best practice metaphors used to exemplify this theory: • The Rider, The Elephant, The Path (used in this template) • Aim, Will, Capacity • ADKAR • Six Change Approach • Business Process Re-engineering • Kaizen • Psychological Concept Theory

13. Direct the Rider • Follow the Bright Spots • Investigate what’s working and clone it • Scientific Approach: • HICPAC Guidelines • 47 separate recommendations • Non-technical approach • APIC Elimination Guide • Bundles Adopting best practices can make you as good as the competition…adapting best practices can make you better.

14. Direct the Rider • Script the Critical Moves • Make the right choice easy • Think in terms of critical behaviors • Hard Stops • Standardization • Checklists • Time Outs • Reminders • References • What looks like resistance may be a lack of clarity • Helpful Tools • Failure Mode and Effect Analysis • Workflow Analysis • Flowcharts/Decision Tree

15. Direct the Rider • Point to the Destination • Explain WHY • Communicate relentlessly • 8 times X 8 ways • Tailor message to the audience • Be truthful • Emphasize what is important to the target audience, but don’t eliminate other motivators • Have clear organizational aims and link the project to the organization’s strategic goals

16. Be one of the safest hospitals in the country • Adverse Events < 36 events per 100 admissions • Core Measure Composites > 75th percentile • All departments >60% for Safety Climate MISSION • Engage and retain employees and physicians. • Employee separation <16% • Employee engagement > 75th %ile • RN vacancy <3.5% • First year Turnover < 30% • Physician satisfaction > 50th %ile • Physician participation in survey >65% • Monitor and respond to customer needs and concerns • HCAHPS measures >75th percentile • Press-Ganey overall satisfaction >80th %ile • Increase market share • Market Share >52% • Market Preference > 52% • Emergency Department Visits > 53,148 • Cardiac Program Procedures > 715 • Admissions >13,059 • Support our mission, vision, and values • EBDITA >$15,092,000 • Cost per Adjusted Admission < $7006 • Foundation Fundraising > $1 million Note: This is a conceptual model used by the Florida Hospital Heartland Division to illustrate the alignment of quality and safety within the organizational mission.

17. Pop Quiz • Who is stronger, the Rider or the Elephant? • The Elephant • The rider can control the elephant’s path while he is strong and refreshed. When he gets tired, the elephant starts to get more freedom to wander in his own direction. It is the same with us. • We can know the right thing to do and know it is important, but if we have to continually make a conscious choice to choose what we should do over what we want to do, eventually we will give in.

18. Move the Elephant • Find the Feeling • Simply knowing what to do isn’t enough • Prevent decision fatigue • Talk in terms of patients, not cases and rates • Learn to say, “We caused…” • Don’t allow rationalization • Share stories • Patient • Family • Staff

19. Move the Elephant • Shrink the Change • Prioritize interventions • Take one bite at a time • Rapid cycle improvement • Small Tests of Change • Choose wisely • Win acceptance by results • You don’t need a randomized, double-blind study or a significant p-value to make decisions Helpful Tools Prioritization Matrix Pick List What can be done by next week

20. Move the Elephant • Grow your People • Create a sense of identity and instill the growth mindset • Engagement • Patient Safety Contract • Front Line team members • Executive Champions • Culture of Learning • Learning from defects • Root Cause Analysis • Global Trigger Tool

21. Shape the Path • Tweak the Environment • When the environment changes, the behavior changes. • So change the situation. • Removing concentrated electrolytes from units • Separating pediatric medications from adult medications • Standardize the central line kit • Important questions • Where else is ____________ done? • Who else does _______________? • Who orders _______________? • Remember to verify changes are still in place

22. Shape the Path • Build Habits • Look for ways to encourage or break habits • Mnemonics: PASS, RACE, APIE, SOAP • Checklists • Time Outs • Education is not an action plan • Benefit limited to those present at the time • Teach the teacher transition of information • Importance of following the instruction becomes diminished as time passes since last defect

23. The Checklist Manifesto The most effective obstacle to effective teams, it turns out, is not the occasional fire-breathing, scalpel-flinging, terror-inducing surgeon…the more familiar and widely dangerous issue is a kind of silent disengagement, the consequence of specialized technicians sticking narrowly to their domains. The evidence suggests we need them to see their job not just as performing their isolated set of tasks but also as helping the group get the best possible results. ~AtulGawande MD

24. Shape the Path • Rally the Herd • Behavior is contagious, help it spread. • Can you create herd immunity • Create a sense of urgency • How much? By when? • Link the process and the outcomes • When the outcome is infrequent, measuring the process provides the motivation and the outcome data provides the celebration. • Constructive competition • Unblind the data • Celebrate successes A dream is just a dream. A goal is a dream with a plan and a deadline. –Harvey Mackay

25. Insert chart/table illustrating recent infection data from CUSP activities

26. Insert chart/table illustrating CLABSI infection rates over entire time of project participation

27. CLABSI Success Summary • Since [Year], central line-associated bloodstream infections have been reduced in the [name units] at [hospital name] by [xx percent]. • Since [Year], approximately [xx] lives have been saved, and [$xxxxx] in excess costs have been saved.

28. Resources • Atul Gawande, The Checklist Manifesto, New York: Metropolitan Books/H. Holt and Co., 2010. • Chip Heath and Dan Heath, Switch: How to Change Things When Change is Hard, New York: Broadway Books, 2010.