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CUSP for Safe Surgery (SUSP) Kickoff Webinar

CUSP for Safe Surgery (SUSP) Kickoff Webinar. Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has. Margaret Mead. Some quick administrative announcements. You need to dial into the conference line to hear audio

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CUSP for Safe Surgery (SUSP) Kickoff Webinar

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  1. CUSP for Safe Surgery (SUSP) Kickoff Webinar Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has. Margaret Mead

  2. Some quick administrative announcements • You need to dial into the conference line to hear audio • Dial in Number: 1-800-311-9401 • Passcode: 83762 • Please contact your Coordinating Entity for a copy of these slides if you have not already received them • We will make a recording of this webinar available to you • We want you to interact with us today

  3. SUSP Kickoff Agenda • Introductions • SUSP Project Overview • Building your SUSP Team • Intro to Building and Measuring Safety Culture • Current Team Experiences • Next Steps

  4. Meet the SUSP National Project Team introductions

  5. Peter Pronovost, MD, PhD, FCCM Principal Investigator Sean Berenholtz, MD, MHS, FCCM State Coach Content Expert Cliff Ko, MD, MS, MSHA, FACS Principal Investigator Charles Bosk, PhD Principal Investigator Ethnographer

  6. Liza Wick, MD State Coach Content Expert Julius Pham, M.D., Ph.D. State Coach Content Expert Bradford Winters, MD State Coach Content Expert Deb Hobson, RN State Coach Content Expert

  7. Lisa Lubomski, PhD Content Expert Mike Rosen, PhD State Coach Content Expert Sallie Weaver, PhD State Coach, Safety Culture Expert Chris Goeschel, ScD, MPA, MPS, RN, FAAN Content Expert

  8. Cathy Van De Ruit Ethnographer Terry Tsai, PhD SUSP Informatics Research Manager KseniaGorbenko, PhD, MA Ethnographer Not pictured: Jeremiah Bowman American College of Surgeons

  9. Kristine Weeks, MHS SUSP Data Consultant Kathryn Taylor, RN, MPH SUSP Program Manager Erin Kirley SUSP Administrative Assistant Tricia Francis, MA, MS, PMP SUSP Project Manager

  10. Laura Vail, MS SUSP IT Specialist Nasir Ismail, MS SUSP Safety Culture Coordinator Erin Hanahan, MPH SUSP Senior Research Coordinator Mary Twomley SUSP Senior Research Coordinator Kelsey Edwards SUSP Research Assistant

  11. Poll – Who is on the call?

  12. We have embarked on a unique journey. Susp project overviewSean Berenholtz, MD, MHS, FCCM

  13. Learning Objectives After this session, you will be able to: • Distinguish SUSP approach from that of other national improvement projects • Describe the connection between SUSP and safety culture work as structured in the Comprehensive Unit-based Safety Program (CUSP) • List the steps for developing a local SSI prevention bundle DRAFT – final pending AHRQ approval

  14. Why is Your SUSP Work Important?1 • 1 in 25 people will undergo surgery • 7 million (25%) in-patient surgeries followed by complication • 1 million (0.5 – 5%) deaths following surgery • 50% of all hospital adverse events are linked to surgery AND are avoidable

  15. Surgical Care Improvement Project (SCIP)2

  16. Engagement Questions: Feel free to type in the chat! • In our institution, near perfect compliance with SCIP measures did not result in decreased SSI rates. Have other people on the call observed the same trends? • Why might that be?

  17. What is SUSP? • AHRQ-funded project • Individual hospitals participate for 2 years • Participation is free • Participation is open to any size hospital, in any state, for any surgical procedure type. • Leveraging leaders in field • Armstrong Institute for Patient Safety and Quality, ACS NSQIP, AHRQ, University of Pennsylvania, WHO

  18. SUSP Enrollment (Cohort 1-3) by Coordinating Entity

  19. Our Shared Project Goals • To achieve significant reductions in surgical site infection and surgical complication rates • To achieve significant improvements in safety culture

  20. Key concepts: Adaptive and Technical Work Sweet Spot

  21. Key concepts: Adaptive and Technical Work

  22. Successful Improvement Work Requires Technical and Adaptive Components Reviewed by The Joint Commission3

  23. Comprehensive Unit-based Safety Program (CUSP) is a model to guide adaptive work4 • Educate everyone on the science of safety • Identify defects • Senior executive partnership • Learn from one defect per quarter • Implement teamwork tools

  24. How is SUSP different? • Informed by science • Led by clinicians and supported by management • Guided by national and local measures • National implementation that can be tailored to local context

  25. We’re Building on Previous Successes on the State Level… • Michigan Keystone ICU program • Reductions in central line-associated blood stream infections (CLABSI)4,5 • Reductions in ventilator-associated pneumonias (VAP) 6 • Improvements in safety climate 7

  26. …And the National Level • National On the CUSP: Stop BSI program8 • A national initiative to implement a proven culture change model, CUSP, and interventions to prevent CLABSI. • A total of 1, 071 ICU’s in 45 states. • A 43% reduction in CLABSI rates. • The number of ICU’s that achieved CLABSI rate of zero, more than doubled.

  27. Teams reduced hospital-acquired infection rates and improved safety culture • “Needs improvement”: Less than 60% of respondents reporting good safety or teamwork culture • Statewide in 2004, 82-84% needed improvement, in 2007 22-23%7

  28. This improvement model has worked in the ORColorectal NSQIP SSI Rate at Hopkins9

  29. SUSP is CUSP for Safe Surgery • This project will teach you to embed adaptive work (CUSP) in your technical work (surgical care). • Unlike other SSI prevention projects, you will develop your own SSI prevention ‘bundle.’ • There is no one ‘right’ bundle for SSI prevention • Engage frontline staff to identify local defects

  30. SUSP Project Management Guide • We have developed monthly modules to guide you through this process. • Each module has ‘deliverables’ for your team, to help you keep your work on track. • Your Coordinating Entity has set up monthly coaching calls to enable horizontal learning. • Please share what you learn on state coaching calls! • You will learn as much (if not more) from each other as you will from us!

  31. SUSP Project Structure • Onboarding Phase (Months 1 – 6) • Module 1: Train Everyone on the Science of Safety & Identifying Defects • Module 2: Engage Senior Executives in SSI Prevention Work • Module 3: Debrief your Safety Culture Scores and SSI data • Module 4: Build your SSI Prevention Bundle • Module 5: Perform an SSI Investigation • Implementation Phase (Months 7 – 18) • Sustainability Phase (Months 19 – 24)

  32. SUSP Project Structure • Onboarding Phase (Months 1 – 6) • Implementation Phase* (Months 7 – 18) • Module 6: Implementing your SSI Prevention Bundle • Module 7: Cohort 4 SUSP Team’s Experience • Module 8: Emerging Evidence: A Surgeon’s Perspective • Module 9: Learning from Defects I • Module 10: Learning from Defects II • Module 11: Optimizing Briefings and Debriefings • Module 12: Auditing Your Briefing and Debriefing Process *Topics subject to change

  33. SUSP Project Structure • Implementation Phase (Months 7 – 18) • Module 13: SUSP “State of the Union” • Module 14: Emerging SUSP Topics • Module 15: Spreading Your SUSP Work • Module 16: Cohort 4 SUSP Team’s Experience • Module 17: Emerging SUSP Topics • Module 18: Cohort 4 SUSP Team’s Experience • Sustainability Phase (Months 19 – 24) *Topics subject to change

  34. SUSP Project Structure • Onboarding Phase (Months 1 – 6) • Implementation Phase (Months 7 – 18) • Sustainability Phase (bimonthly calls, Months 19 – 24) • Module 19: SUSP Project Sustainability I • Module 20: SUSP Project Sustainability II • Module 21: SUSP Project Wrap-Up

  35. Real Time Feedback (Poll) • How ready is your organization to 1) enable frontline participation in improvement work and 2) address frontline patient safety priorities?

  36. References • World Health Organization. New Scientific Evidence Supports WHO Findings: A Surgical Safety Checklist Could Save Hundreds of Thousands of Lives. http://www.who.int/patientsafety/challenge/safe.surgery/en/. Accessed August 7, 2013. • Centers for Medicare and Medicaid Services. National Impact Assessment of Medicare Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF. Published March 2012. Accessed August 7, 2013. • The Joint Commission, Sentinel Event Data. http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29. AccessedAugust 8, 2013. • Pronovost P, Needham D Berenholtz S, et al. An Intervention to Decrease Catheter-related Bloodstream Infections in the ICU. N Engl J Med. 2007;356(25):2660. • Pronovost P, Goeschel C, Colantuoni E, et al. Sustaining Reductions in Catheter Related Bloodstream Infections in Michigan Intensive Care Units: Observational Study. BMJ. 2010; 340:c309.

  37. References • Berenholtz S, Pham J, Thompson D, et al. Collaborative cohort Study of an Intervention to Reduce Ventilator-associated Pneumonia in the Intensive Care Unit. Infect Control HospEpidemiol. 2011; 32(4): 305–314. • Sexton JB, Berenholtz SM, Goeschel CA, et al. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Medicine. 2011 May;(39(5):934-9. • Website of the National Implementation of the Comprehensive Unit-based Safety Program to Eliminate Health Care-Associated Infections. http://www.onthecuspstophai.org/. Accessed August 7, 2013. • Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2). • The Joint Commission. J Qual Patient Saf. 2010;36:252-6http://www.ahrq.gov/cusptoolkit/

  38. Who is in the room with you? Building your susp teammike rosen, phd

  39. Poll • Do you have a SUSP team? • If so, who is on your team?

  40. Learning Objectives After this session, you will be able to: • Develop a strategy to engage frontline and executive team members in SUSP work • Utilize basic strategies to encourage surgeon participation in SUSP work • Identify SUSP team members and plan your first meeting

  41. StephMullens CST Lead Tech Executive Kevin Driscoll CRNA CRNA Lead Renee Demski MBA Senior Director Quality Johns Hopkins Medicine Mary Grace Hensel RN Manager OR Elizabeth Wick MD Surgery Lead Sean Berenholtz MD Anesthesia Lead Deb Hobson RN “Coach” Tracie Cometa RN Lead RN Coach NSQIP Outcomes Lucy Mitchell RN NSQIP SCR

  42. Perioperative SUSP Team Members Essential Team Members • Surgeons • Anesthesiologists • CRNAs • Circulating nurses • Scrub nurses / OR techs • Perioperative nurses • Executive partner • Nurse leaders Enhancing Team Members • Physician assistants • Nurse educators • Anesthesia assistants • Infection preventionists • OR directors • Patient safety officers • Chief quality officers • Ancillary staff

  43. The SUSP Team • Understands that patient safety culture is local • Composed of engaged frontline providers who take ownership of patient safety • Includes staff members who have different levels of experience • Tailored to include members based on clinical intervention • Meets regularly (weekly or at least monthly) • Has adequate resources including protected time • 2 to 4 hours per week for a team leader, surgeon, anesthesia, nurse, and infection preventionist

  44. Engagement question: Feel free to type in the chat! • How will you help create 2 – 4 hours of protected time for your SUSP team leaders?

  45. SUSP Teams’ Group Processes • Role Clarity • Norms • Effective Team • Communication • Effective Group Processes • Leadership • Buy-in and Support • Conflict Resolution • Education • and Engagement

  46. The Senior Executive’s Role • Helps the team prioritize improvement efforts • Helps the team navigate organizational bureaucracy • Ensures the SUSP team has resources to fix problems • “Comes out of the office” to meet monthly with members of health care team in their clinical area

  47. Contacting an Executive Partner • Contact hospital management to determine which senior executive will best fit the perioperative area and the following criteria: • Director level or above • Available to round for at least one hour per month • Approachable and comfortable with sensitive topics • Set up a meeting to introduce the project, provide a tour of the perioperative area, and share unit-level information

  48. The Surgeon Leader’s Role • Serves as role model for SUSP activities • Meets with SUSP team at least monthly • Participates in monthly senior executive partnership meetings • Communicates with physician group as needed • Assists with implementation of interventions

  49. Engage Surgeons on the SUSP Team • Identify surgeon leaders • Create an understanding of this role • Listen to surgeon concerns • Develop plans to address concerns • Reward surgeon leaders • Create a vehicle for communication • Develop a plan for communications

  50. Practical Tips for Scheduling Your SUSP Meetings • Incorporate SUSP meetings into ongoing educational activities to ease scheduling challenges • Regularly scheduled nurse training • Grand rounds for physicians • Invite RNs to joint grand rounds • Create incentives for participating

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