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Practical Tips for Getting a CUSP Team Started
Armstrong Institute for Patient Safety and Quality
1© JHU and JHHS, 2011
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
© JHU and JHHS, 2011
2
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
3
© JHU and JHHS, 2011
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
4
© JHU and JHHS, 2011
Preparing for the
Kick-off Meeting (CUSP Step 3)
Pre-CUSP
1. Conduct the Culture
Assessment
2. Establish an
Interdisciplinary CUSP
Team
3. Partner with a Senior
Executive
4. Gather Unit Information
© JHU and JHHS, 2011
5
CUSP
1. 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
CUSP Overview
• Goals:
– Improve patient safety and safety culture
– Integrate safety practices into daily work
• Implement at unit level
• Cyclical improvement processes (not linear)
6
© JHU and JHHS, 2011
Pre-CUSP
Step 1: Culture Assessment
1. Conduct the Culture Assessment
2. Discuss your results
© JHU and JHHS, 2011
7
Pre-CUSP Work
Step 2
8
© JHU and JHHS, 2011
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
Senior Hospital Executive
Senior
Hospital
Executive
Armstrong Institute for Patient Safety and Quality
9
• 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
Manager
Manager
Armstrong Institute for Patient Safety and Quality
10
• 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
Unit Champion
Unit
Champion
Armstrong Institute for Patient Safety and Quality
11
• 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
Physician Champion
Physician
Champion
Armstrong Institute for Patient Safety and Quality
12
• Review and identify problems
• Assist in the implementation of interventions
• Communicates with physician group as needed
CUSP Expert/Facilitator
CUSP
Expert/
Facilitator
Armstrong Institute for Patient Safety and Quality
13
• 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
Patient Safety Coordinator/Patient
Safety Officer
Patient Safety
Coordinator /
Patient Safety
Officer
Armstrong Institute for Patient Safety and Quality
14
• 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
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
© JHU and JHHS, 2011
15
Pre-CUSP
Step 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
© JHU and JHHS, 2011
16
Pre-CUSP
Step 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
© JHU and JHHS, 2011
17
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
18
© JHU and JHHS, 2011
Steps 1 & 2 Occur
Simultaneously
• 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
© JHU and JHHS, 2011
19
Science of Safety Training
Step 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)
20
© JHU and JHHS, 2011
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 staff
21
© JHU and JHHS, 2011
Staff Identify Defects
Step 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)
22
© JHU and JHHS, 2011
Staff Safety Assessment
2 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 leader
Thank you for helping improve safety in your workplace!
23
© JHU and JHHS, 2011
Source: Adapted from the Johns Hopkins Hospital CUSP Manual of Operations
Consider Other Data
• Consider other data sources, such as:
– Event reports
– Sentinel events
– Patient satisfaction
– M&Ms
– Culture survey results
© JHU and JHHS, 2011
24
Preparing for Kick-off
© JHU and JHHS, 2011
25
• 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
CUSP Kick-off Template
Page 1
© JHU and JHHS, 2011
26
CUSP Kick-off Template
Page 2
© JHU and JHHS, 2011
27
Discuss key points:
How do the scores
compare?
What scored low?
What scored high?
CUSP Kick-off Template
Page 3
© JHU and JHHS, 2011
28
Add data from an event reporting system if
your organization captures this information.
CUSP Kick-off Template
Page 4
© JHU and JHHS, 2011
29
This is a summary of key categories.
You may add other categories, such as “falls.”
CUSP Kick-off Template
Pages 5 & 6
© JHU and JHHS, 2011
30Fill-in answers verbatim from the 2 Question Survey
2 Weeks Before the
Kick-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
© JHU and JHHS, 2011
31
The Kick-off Meeting
Step 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
© JHU and JHHS, 2011
32
Kick-off Meeting
What 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
© JHU and JHHS, 2011
33
WICUPOSTCUSP
--SICUPOSTCUSP
--SICUTime3
--WICUTime3
WICUPRECUSP
SICUPRECUSP
0
10
20
30
40
50
60
70
80
90
100
S IC U
P R E
C U S P
%ofrespondentswithinaclinicalarea
reportinggoodsafetyclimate
Safety Climate Across 100 Clinical Areas
WICU & SICU Climate Pre-Post CUSP
Change in Safety Climate
© JHU and JHHS, 2011
34
35
© JHU and JHHS, 2011
For more information and tools on the other
steps of CUSP, and other patient safety
programs visit our website:
www.hopkinsmedicine.org/armstron
ginstitute

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Practical tipsgettingcusp teamstarteddbh 4.2014

  • 1. Practical Tips for Getting a CUSP Team Started Armstrong Institute for Patient Safety and Quality 1© JHU and JHHS, 2011
  • 2. 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 © JHU and JHHS, 2011 2
  • 3. 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 3 © JHU and JHHS, 2011
  • 4. 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 4 © JHU and JHHS, 2011
  • 5. Preparing for the Kick-off Meeting (CUSP Step 3) Pre-CUSP 1. Conduct the Culture Assessment 2. Establish an Interdisciplinary CUSP Team 3. Partner with a Senior Executive 4. Gather Unit Information © JHU and JHHS, 2011 5 CUSP 1. 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
  • 6. CUSP Overview • Goals: – Improve patient safety and safety culture – Integrate safety practices into daily work • Implement at unit level • Cyclical improvement processes (not linear) 6 © JHU and JHHS, 2011
  • 7. Pre-CUSP Step 1: Culture Assessment 1. Conduct the Culture Assessment 2. Discuss your results © JHU and JHHS, 2011 7
  • 8. Pre-CUSP Work Step 2 8 © JHU and JHHS, 2011 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
  • 9. Senior Hospital Executive Senior Hospital Executive Armstrong Institute for Patient Safety and Quality 9 • 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
  • 10. Manager Manager Armstrong Institute for Patient Safety and Quality 10 • 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
  • 11. Unit Champion Unit Champion Armstrong Institute for Patient Safety and Quality 11 • 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
  • 12. Physician Champion Physician Champion Armstrong Institute for Patient Safety and Quality 12 • Review and identify problems • Assist in the implementation of interventions • Communicates with physician group as needed
  • 13. CUSP Expert/Facilitator CUSP Expert/ Facilitator Armstrong Institute for Patient Safety and Quality 13 • 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
  • 14. Patient Safety Coordinator/Patient Safety Officer Patient Safety Coordinator / Patient Safety Officer Armstrong Institute for Patient Safety and Quality 14 • 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
  • 15. 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 © JHU and JHHS, 2011 15
  • 16. Pre-CUSP Step 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 © JHU and JHHS, 2011 16
  • 17. Pre-CUSP Step 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 © JHU and JHHS, 2011 17
  • 18. 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 18 © JHU and JHHS, 2011
  • 19. Steps 1 & 2 Occur Simultaneously • 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 © JHU and JHHS, 2011 19
  • 20. Science of Safety Training Step 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) 20 © JHU and JHHS, 2011
  • 21. 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 staff 21 © JHU and JHHS, 2011
  • 22. Staff Identify Defects Step 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) 22 © JHU and JHHS, 2011
  • 23. Staff Safety Assessment 2 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 leader Thank you for helping improve safety in your workplace! 23 © JHU and JHHS, 2011 Source: Adapted from the Johns Hopkins Hospital CUSP Manual of Operations
  • 24. Consider Other Data • Consider other data sources, such as: – Event reports – Sentinel events – Patient satisfaction – M&Ms – Culture survey results © JHU and JHHS, 2011 24
  • 25. Preparing for Kick-off © JHU and JHHS, 2011 25 • 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
  • 26. CUSP Kick-off Template Page 1 © JHU and JHHS, 2011 26
  • 27. CUSP Kick-off Template Page 2 © JHU and JHHS, 2011 27 Discuss key points: How do the scores compare? What scored low? What scored high?
  • 28. CUSP Kick-off Template Page 3 © JHU and JHHS, 2011 28 Add data from an event reporting system if your organization captures this information.
  • 29. CUSP Kick-off Template Page 4 © JHU and JHHS, 2011 29 This is a summary of key categories. You may add other categories, such as “falls.”
  • 30. CUSP Kick-off Template Pages 5 & 6 © JHU and JHHS, 2011 30Fill-in answers verbatim from the 2 Question Survey
  • 31. 2 Weeks Before the Kick-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 © JHU and JHHS, 2011 31
  • 32. The Kick-off Meeting Step 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 © JHU and JHHS, 2011 32
  • 33. Kick-off Meeting What 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 © JHU and JHHS, 2011 33
  • 34. WICUPOSTCUSP --SICUPOSTCUSP --SICUTime3 --WICUTime3 WICUPRECUSP SICUPRECUSP 0 10 20 30 40 50 60 70 80 90 100 S IC U P R E C U S P %ofrespondentswithinaclinicalarea reportinggoodsafetyclimate Safety Climate Across 100 Clinical Areas WICU & SICU Climate Pre-Post CUSP Change in Safety Climate © JHU and JHHS, 2011 34
  • 35. 35 © JHU and JHHS, 2011 For more information and tools on the other steps of CUSP, and other patient safety programs visit our website: www.hopkinsmedicine.org/armstron ginstitute