On the CUSP: Stop BSI NICU Project

1. On the CUSP: Stop BSI NICU Project Supplemental Coaching Call For Late Comers and Others Needing Extra Help 3/19/2012 Pat Posa RN, BSN, MSA Kimberly O’Brien, MHA System Performance Improvement Leader Director, Program Development St. Joseph Mercy Health System Missouri Center for Patient Safety Ann Arbor, MI Jefferson City, MO patposa@comcast.netkobrien@mocps.org

2. Common Questions What is CUSP? How is it different from other quality improvement initiatives such as CQI, Six Sigma and/or Lean? What are the benefits of implementing CUSP? How is this training module structured? How do I get unit staff engaged in CUSP? How do I get physicians engaged in CUSP? How do I recruit an executive sponsor? How do I get started if I came on board late?

3. What is CUSP? • Comprehensive Unit-based Safety Program • Researched and developed by Johns Hopkins University • Designed to improve patient safety culture at the unit level to drive improved patient care, staff communication and clinical outcomes • Piloted in Michigan – Keystone Project • 127 ICUs implemented CUSP and the CLABSI evidence bundle – reduced CLABSIs by 66% • Sustained a median of zero CLABSIs for over 5 years • National collaboratives – NICU CABSI, CLABSI and CAUTI (adult) • Can be used to improve any clinical problem area

4. What is CUSP? Educate on the Science of Safety Identify Defects (Staff Safety Assessment) Senior Executive Partnership Learn from Defects Implement Teamwork & Communication Tools

5. How is CUSP different? • CUSP identifies problem areas – • what staff think are impeding patient care vs. what managers/directors think are priority areas • CUSP improvement tools are designed for bedside caregivers – easy for busy staff to use • unit drives its own quality • Lean/Six Sigma/CQI – focus more on streamlining the process than identifying the problem areas • CUSP can complement other quality improvement methods – must use multiple tools!

6. What are the benefits of CUSP? Fix medical errors before they happen—improving patient safety Improve unit culture Improve mortality/morbidity Improve patient care/satisfaction at the bedside Improve staff satisfaction Improve physician satisfaction Improve resource utilization Surviving the current and future regulatory climate Evidence-based practice

7. How is the CUSP portion of the NICU CABSI Collaborative structured? • 5 monthly coaching calls, in which CUSP faculty walk team leaders through each step of implementing CUSP - 01/2012 – 06/2012 • Establish a CUSP team, executive sponsor • Educate unit staff on the Science of Safety/perform Staff Safety Assessment to identify defects/prioritize defects • How will the next patient be harmed? • What can be done to prevent that harm from happening? • Fix/learn from one defect identified by unit staff • Each coaching call has follow-up action items before the next coaching call • CUSP team leader attends the calls (with physician, if possible) • CUSP team leader facilitates team meeting once or twice a month • Complete action items before next coaching call

8. How do I get staff engaged? • Staff safety assessment—ask the questions and then begin to learn/resolve defects in care • Seek out the informal leaders on each shift and get their support and involvement—others will follow • Discussions on unit, at staff meetings and unit councils about the role of all staff regarding patient safety • Share stories of where harm is occurring and that we all need to work together to prevent future harm • Make sure to keep the ‘patient’ as the focus in all that you do

9. How do I get physicians engaged? • Find a champion first: respected, knowledgeable, willing to dialogue with other physicians • Share the issues (why do we need to do this), the process and the evidence of the impact of this type of program • Meet with physician champion regularly to ensure continued engagement and define/discuss strategies to engage other physicians • Make sure to keep the ‘patient’ as the focus in all that you do

10. How do I recruit an executive sponsor? • Discuss with senior leadership • Develop hospital-wide strategy to have executive sponsor a specific unit • Define clear role of executive sponsor-should be consistent for each unit • Effective Executive Practices: • Counteracting resistance and helping people to learn in psychologically safe way • Listening/Empathy –help staff to feel heard, you can not always solve a problem, but to demonstrate that they taught you something is a valuable and often missed opportunity for leadership. • Willingness to address the gap between the values that people hold, and the reality that they face • Providing vision, and giving clarity and articulation to the goals of the unit/clinical area (reification)

11. How do I get started if I joined late? • If you missed Coaching Call 1, listen to the audio file recordings with the accompanying slides: http://www.onthecuspstophai.org/stop-bsi/ncabsi-the-nicu-collaborative/nicu-educational-calls-and-webinars/ • Establish a unit-based team • Work through the action items on the Team Leader Monthly Checklist for Coaching Call 1 (there will be a checklist for each coaching call) • http://www.onthecuspstophai.org/stop-bsi/ncabsi-the-nicu-collaborative/ncabsi-coaching-call-resources/ • You may have to establish new timelines to educate staff on the Science of Safety and perform the Staff Safety Assessment • Attend Coaching Call 2 on 3/28 (2:00pm Central Time)

12. Questions?