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CUSP CAUTI: National Content Call

CUSP CAUTI: National Content Call. Tuesday, February 11, 2014 Creating a Culture of Safety:  The Power of Conversation. Preview of Today’s Call. The power of conversation How conversation influences the culture of safety in an organization

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CUSP CAUTI: National Content Call

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  1. CUSP CAUTI: National Content Call Tuesday, February 11, 2014 Creating a Culture of Safety:  The Power of Conversation

  2. Preview of Today’s Call The power of conversation How conversation influences the culture of safety in an organization Utilizing the Team Check Up tool to help facilitate your conversations Success stories and lessons learned from hospitals who have utilized the TCT

  3. Today’s Presenters: Linda Greene, RN, MPS, CICManager of Infection PreventionHighland Hospital in Rochester, NY Michele Clark, MBA Program Director Kansas Healthcare Collaborative

  4. Today’s Presenters: Jamie Cravens Via Christi Pittsburg Pittsburg, Kansas Sheila McCullough-Culver Hodgeman County Health CenterJetmore, Kansas Shawn Horton Kearny County HospitalLakin, Kansas

  5. National Content Call Creating a Culture of Safety:  The Power of Conversation Linda R. Greene RN,MPS,CIC linda_greene@urmc.rochester.edu

  6. The Power of Conversation From project leader, front line caregivers to administrators, the power of conversation can be leveraged systemically to help move hospitals to high levels of patient safety

  7. Polling Question What is your role? • Team Member • Team Leader • State Lead • Extended faculty • Other

  8. Guiding a Conversation • Team-based interventions are effective for improving safety and the quality of healthcare. • Associated issues such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. • The science for measuring these issues is still immature

  9. Creating the Culture • How do we create a culture of clinical excellence and inspire and motivate staff ? • Guided conversations surface and address critical issues while respecting the wisdom and the feedback of frontline caregivers

  10. Culture What is culture? (climate) “The way we do things around here.” 1 person’s attitude = opinion Everyone’s attitude = culture

  11. The Objective Improve teamwork and communication….ultimately, creating a culture of safety….. It starts with conversation

  12. Team Check Up Tool (TCT) A Critical Tool to Gauge Progress Measures BOTH Adaptive and Technical Change Helps to monitor progress of CUSP steps and CAUTI reduction steps Identifies specific behaviors of team leaders that drive performance Helps identify barriers in teamwork and communication to guide corrective action

  13. Genesis of the Team Check Up Tool CUSP CLABSI • To bring to the surface barriers for successful intervention implementation and provide feedback to senior leaders regarding these barriers, ICU teams were surveyed monthly using a “team checkup” survey. • Members were asked their perceptions about the adequacy of physician and senior leader support, time to implement the interventions, and support for data collection.

  14. Hopkins CUSP Model Framework

  15. Science Supports TCT Validity and usefulness of members reports of implementation progress in a quality improvement initiative: findings from the Team Check Up Tool (TCT): Cluster Randomized RCT – The TCT demonstrates good measurement reliability, validity, and response. QI teams participating in an intervention should find data from a validated tool useful for identifying opportunities to improve their own implementation • Chanet al. http://www.implementationscience.com/content/6/1/115

  16. Polling Question: I use the team check up tool: • Regularly • Occasionally • Never

  17. Tools for Guiding the Conversation The Team Check- Up tool is much like a GPS. It is our guide to facilitate conversation.

  18. How is the Tool Used?

  19. Starting the Conversation Conversation is the means by which existing knowledge is conveyed and new knowledge is generated Emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges). “The Wisdom of Crowds”- Suroweicki Baseline data can challenge the current view of reality and place a greater emphasis on understanding.- Pronovost

  20. The Team The CAUTI Team reviews the tool and identifies barriers to team progress. This leads to a conversation about safety engagementand staff begin to assess the reasons for lack of nurse and physician “buy in” and ultimately begin to generate solutions.

  21. State Leads The state lead reviews the TCTs. He / She notices that a majority of teams do not have the patient safety video as part of general orientation and that in most organizations, less than 50% of the staff have viewed the Science of Safety Video. This becomes a topic of discussion during the monthly call. Teams that have shown progress share their strategies.

  22. Faculty The Faculty works with the State Lead to develop structured conversation around responses to the TCT. This begins a dialogue on the coaching calls specific to patterns and trends identified on the calls with input from various teams.

  23. Administrators The administrator assigned to a specific CAUTI team is reviewing results of the TCT. It is apparent that the team needs more administrative support and that results of team activities and outcome data have not reached the board or senior executive level. This leads to a conversation regarding barriers and opportunities for transparency and awareness.

  24. You The TCT is a tool for your important discussions with your unit team. If  you haven’t reviewed your TCTs in a while please ask your state lead and faculty coach for assistance and feedback. It is everyone’s responsibility for initiating the conversation. Don’t hesitate to ask a question during your coaching calls. An example might be “We’re having difficulty with_____ how have others dealt with these issues?”

  25. TCT Current TCT response rate is only 36% Why do you think this is the case?

  26. Polling Question Which answer would best describe your response to the use of team check up tool • I have found it helpful • It is too time consuming • I do not find it useful • I did not understand the way it should be used • It seems redundant

  27. Polling Question What are the barriers to using the Team Check-up Tool? • Time • Knowledge • Team Engagement/Structure • Value • All of the Above

  28. How we have used the TCT Kansas on the CUSP: Stop CAUTI State Lead: Michele Clark, MBA, ABC KHC Program Director In partnership with

  29. About Kansas on the CUSP:Stop CAUTI To date, 71 Kansas hospitals (3 groups or cohorts) have participated in 18-month CAUTI/CUSP project. All hospitals now in sustainability period, cohort 5 active.

  30. Background • Monthly coaching calls, project guidance and technical assistance. • Combined support to hospitals from HRET, KHC, KFMC, MHA Keystone Center and national faculty • Kansas State lead changed in April 2012 (cohort 3 gearing up, cohort 2 winding down) • In January 2013, new cohort 5 joined coaching calls with cohort 3 (in progress)

  31. Team Check Up Tool Statewide view • State lead identifies top 5 barriers for all cohorts. • Not enough time • Staff distraction due to competing priorities • Staff distraction due to other events in unit/hospital • Not enough buy-in from unit nurses • Not enough leadership support from physicians • Drill down in TCT responses to find cohort 3 teams that have overcome them. • Experiences shared in monthly coaching call.

  32. Team Check Up Tool • ~60% of Kansas Cohort 5 units complete TCT each quarter. • Efficiently allows state lead to monitor activities and progress at unit level and as a group. • Common Barriers report helps state lead identify opportunities for peer-to-peer conversations.

  33. National Content Call Via Christi Hospital Pittsburg, Inc. Pittsburg, KS Jamie Cravens, RN Infection Control Pittsburg

  34. How we use the TCT • Used TCT as a guide and to keep on track. • Confirmed what we’re doing right and areas to work on. • Used as a guide to start conversations, remove barriers and engage people with the data. • Learning from Defects is the greatest tool we have. • Pearls of wisdom: • It takes continuous education and communication to get anything ingrained in the system. • Prioritize meetings and huddles on a daily basis. Weekends, too. • Get front line staff to lead and be a big part of the process.

  35. National Content Call Hodgeman County Health Center Jetmore, KS Jetmore Sheila McCullough-Culver, MPH, BSN, RN Risk Management, Quality Assurance, Infection Prevention, Employee Health

  36. How we use the TCT • TCT serves as a guide for making progress during CAUTI project. • Informal, relaxed approach is important to garner cooperation among small, busy staff. • Take opportunity to discuss CAUTI and patient safety during acute staff meeting, safety committee, QA. • Currently in approval process of adopting nurse-led protocol and showing Science of Safety video at manager meetings.

  37. National Content Call Kearny County Hospital Lakin, KS Lakin Shawn Horton, RN Nursing Supervisor Surgical Services & Infection Control

  38. How we use the TCT • New IC at rural hospital, no active program,one-man team • TCT provided ideas for engagement, program. Adapted for one-man team at small hospital. • Formed IC committee. Using meetings and skills fairs to spread education and get group feedback. • Medical director, CNO, administrator and many others became part of one-man’s team perhaps without realizing it. • A work-in-progress.

  39. Where is the TCT on your agenda? Here are few things you can do: • Start the conversation • Use the state lead and/or expert faculty to assist you • Monitor your team progress over time • Identify barriers and discuss solutions • Discuss barriers and solutions with your peers, for example on your state coaching call

  40. Thank you! Questions for our presenters?

  41. Your Feedback is Important We rely on your opinion to shape future content calls. At the end of today’s call, please complete our survey using this link:CAUTI Content Call Evaluation

  42. National Content Call Series

  43. March Content Call Preview • How Surveillance and Practice Affect your CAUTI Efforts, Presented by Dr. Mohamad Fakih • The call will cover the following: • Relation between catheter use and bacteriuria • What triggers a urine culture? • How do we define CAUTI? • When to (or not) obtain urine cultures • Bacteriuria and antimicrobial use

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