Practical tipsgettingcusp teamstarteddbh 4.2014

© JHU and JHHS, 2011 1

Practical Tips for Getting a CUSP Team Started

Armstrong Institute for Patient Safety and Quality

© JHU and JHHS, 2011

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Overview of CUSP

• This training will focus on tips for getting a CUSP team started and ready for the Kick-off Meeting, from Pre-CUSP through Step 2 of CUSP

• For an overview of CUSP please view the training: “Introduction to the Johns Hopkins Comprehensive Unit-Based Patient Safety Program (CUSP)”– Available at:

• http://www.hopkinsmedicine.org/armstrong_institute


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Objectives

• Discuss Pre-CUSP and CUSP steps

• Identify the challenges most frequently encountered during the Pre-CUSP and early CUSP implementation periods, prior to the Kick-off Meeting

• Describe methods to overcome challenges for a successful CUSP kick-off and implementation


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Unit Level Approach

• The Johns Hopkins safety program has focused on teams at the unit level to improve safety culture and lead to measurable improvements in safety

• This program is known as “CUSP” the Comprehensive Unit-Based Safety Program


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Preparing for the Kick-off Meeting (CUSP Step 3)

Pre-CUSP1. Conduct the Culture

Assessment

2. Establish an Interdisciplinary CUSP Team

3. Partner with a Senior Executive

4. Gather Unit Information

CUSP1. Train Staff in the Science

of Safety

2. Engage Staff to Identify Defects

3. Senior Executive Partnership/Safety Rounds (Kick-off Meeting)

4. Continue to Learn from Defects

5. Implement Tools for Improvement


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CUSP Overview

• Goals: – Improve patient safety and safety culture– Integrate safety practices into daily work

• Implement at unit level

• Cyclical improvement processes (not linear)


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Pre-CUSPStep 1: Culture Assessment

1. Conduct the Culture Assessment

2. Discuss your results


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Pre-CUSP WorkStep 2

2. Establish an Interdisciplinary CUSP Team– The driving force of in keeping the momentum

– Representative of all people who work on the unit• Multidisciplinary

• Different levels of experience or training

• Allow for members to join at any time

– Create a Safety Team Contact List and make visible for reference


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Senior Hospital Executive

Senior Hospital Executive

• Help surface safety hazards through open discussions with unit staff

• Make rounds on assigned unit and meet with key members of the health care team

• Help the team prioritize needed improvements

• Provide resources for improvement efforts

• Department Administrators, Department Chairs and Directors of nursing should be invited to participate in rounds

• Help the team learn from defects using the LFD tool


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Manager

Manager

• Supports CUSP process

• Manages resources

• Assures survey results are shared with staff

• Assigns project leaders to interventions

• Assists in scheduling executive walk rounds

• May serve as the Unit Champion


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Unit Champion

Unit Champion

• Encourages unit staff involvement

• Obtains staff feedback

• Manages documentation of CUSP program

• Educates staff about CUSP

• Champions patient safety efforts on unit

• Assists in setting up meetings

• Documents data collection, use of CUSP tools, and record of successes and opportunities for improvement


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Physician Champion

Physician Champion

• Review and identify problems

• Assist in the implementation of interventions

• Communicates with physician group as needed


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CUSP Expert/Facilitator

CUSP Expert/ Facilitator

• Content expert for CUSP program, use of the CUSP toolkit and the Science of Safety

• Mentors executive regarding his/her role in improving unit safety

• Mentors unit champion in project management skills

• Contact person for questions

• Helps identify resources


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Patient Safety Coordinator/Patient Safety Officer

Patient Safety Coordinator / Patient Safety

Officer

• May serve as Senior Executive in some institutions

• Coordinates Executive orientation

• Assures Expert is assigned

• Verifies surveys are analyzed and results are reviewed in a timely manner

• Monitors progress

• Helps to disseminate results and share stories


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Accountability & Ownership

• Safety is not just the responsibility of the direct care giver

• To launch effective safety and quality efforts you must incorporate roles so that everyone on the team plays a part and shares their expertise and perspective


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Pre-CUSPStep 3

3. Partner with a Senior Executive– Contact hospital management to determine which senior executive will best fit

the unit and who meet the following criteria:

• Director level or above

• Available to round for at least 1 hour per month

• Approachable and comfortable with sensitive topics

– Meet with the senior executive to secure his/her commitment to the program

– Have the senior executive participate in the Science of Safety Training

– Schedule the Kick-off Meeting

• 1 hour meeting, on the unit, half of time spent meeting, half spent walking around the unit

• Schedule the senior executive for 1.5 hours to ensure he/she has plenty of time to spend with the team


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Pre-CUSPStep 4

4. Gather Unit Information– This includes the baseline results of the safety

culture survey as well as other unit-specific data that will be beneficial to the senior executive• Culture Survey Results• List of safety issues

– Event reporting system summaries

• Unit statistics such as:– Number of beds– Staff turnovers– Infection rates– Serious events


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1. Train Staff in the Science of Safety

2. Engage staff to Identify Defects (2 Question Survey)

3. Senior Executive Partnership/Safety Rounds (Kick-off Meeting)

4. Continue to Learn from Defects

5. Implement Tools for Improvement

CUSP Steps


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Steps 1 & 2 OccurSimultaneously• Offer the Science of Safety training several times during the

month before the Kick-off Meeting and conclude the training with the 2 Question Survey

• The goal is for 100% of staff (who spend 50% or greater of their time in unit) to attend and complete the 2 Question Survey– Also include other disciplines who have roles in the unit. For

example respiratory therapist, physical therapist, EKG technician, point-of-care pharmacists

• Keep a sign-in sheet


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Science of Safety TrainingStep 1

• Purpose: explain patient safety problem, introduce investigation of system defects, highlight how they can make a difference

• Process: – Watch Josie King & Science of Safety videos– Large group training and mixture of disciplines most

effective– Track staff trained with attendance sheet (form)

Science of Safety Training?

• What should your organization use for Science of Safety Training

– On-line “Hopkins” Science of Safety?• AHRQ• YouTube• MyLearning

– Create your own• Utilize stories from your own organization that will

resonate with staff21



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Staff Identify DefectsStep 2: (2 Question Survey)

• Purpose:

– Tap into expertise and knowledge of frontline providers

– Empower & engage in safety

• Process:

– Staff safety assessment survey (2 Question Survey)

– Assign one person task of survey administration

– Collate & group responses into common defects (e.g., communication, patient falls)


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Staff Safety Assessment2 Question Survey

Please describe what you think can be done to prevent or minimize this harm:

Please describe how you think the next patient in your unit/clinical area will be harmed:

• Name: can be left blank• Job Category:• Date:• Unit:

Return this form to your project leaderThank you for helping improve safety in your workplace!

Source: Adapted from the Johns Hopkins Hospital CUSP Manual of Operations


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Consider Other Data

• Consider other data sources, such as:

– Event reports

– Sentinel events

– Patient satisfaction

– M&Ms

– Culture survey results


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Preparing for Kick-off

• Create the Kick-off Meeting Document by:

– Completing the Johns Hopkins Hospital Kick-off Meeting Template with all data obtained during Pre-CUSP and CUSP Steps 1 & 2


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CUSP Kick-off TemplatePage 1


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Discuss key points:

How do the scores compare?

What scored low?

What scored high?


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Add data from an event reporting system if your organization captures this information.


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This is a summary of key categories. You may add other categories, such as “falls.”


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CUSP Kick-off TemplatePages 5 & 6

Fill-in answers verbatim from the 2 Question Survey


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2 Weeks Before theKick-off Meeting

• Meet with and provide the Kick-off Meeting Information to:– Senior Executive– Unit Champion– Physician Champion

• Be sure they are prepared in advance


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The Kick-off MeetingStep 3

• Begin Step 3 “Senior Executive Partnership/Safety Rounds”

• Utilize the Kick-off Template you completed to launch the Kick-off Meeting with the CUSP team and the senior executive

– Introduce CUSP– Review patient safety information– Prioritize improvement projects – Secure everyone’s commitment to the program


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Kick-off MeetingWhat to Expect:

• Have copies of the Kick-off Template for each team member

• Utilize Kick-off Template as an agenda and talking points for the meeting

• Team members may be quiet initially

• It will take time (2 to 4 months) to get off the ground

• This is the normal progression of a new group


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Safety Climate Across 100 Clinical AreasWICU & SICU Climate Pre-Post CUSP

Change in Safety Climate


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For more information and tools on the other steps of CUSP, and other patient safety programs visit our website:

www.hopkinsmedicine.org/armstronginstitute

Practical tipsgettingcusp teamstarteddbh 4.2014

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