slide1
Download
Skip this Video
Download Presentation
Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project

Loading in 2 Seconds...

play fullscreen
1 / 24

Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project - PowerPoint PPT Presentation


  • 147 Views
  • Uploaded on

Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project. AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust. Presentation Overview. CUSP: CLABSI Project Origins and Background

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project' - karsen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Building National Health CareQuality Improvement Campaigns to Succeed:Lessons from the CUSP: CLABSI Project

AHRQ Annual Meeting

Sept. 27, 2010

Steve Hines, PhD

Health Research and Educational Trust

presentation overview
Presentation Overview
  • CUSP: CLABSI Project Origins and Background
  • The Challenge of Evolving a National Project
  • Implications for Project Design and Planning
  • Final Thoughts
project origins and background
Project Origins and Background

In the beginning was the Keystone Project . . .

. . . and it was very good!

cusp clabsi project rationale
CUSP: CLABSI Project Rationale
  • Blood stream infections kill 40,000-60,000 persons each year.
  • Reducing the BSI rate from 5 per 1,000 days to 1 per 1,000 days will save 20,000 lives annually.
  • Michigan Keystone Project showed that this level of reduced CLABSI rate was achievable and sustainable.
  • Project made central part of Secretary Sibelius’ Healthcare Acquired Infection Reduction Initiative.
cusp clabsi project goals
CUSP: CLABSI Project Goals
  • Outcome Goals:
    • Reduce BSIs to 1 per 1,000 central line days
    • Some states and hospitals view CLABSI elimination as the goal
    • Improve unit safety culture
  • Reach hospitals in all 50 states, the District and Puerto Rico
  • Include both ICUs and other units with CLABSI risks
  • Include critical access hospitals
cusp clabsi implementation content
CUSP: CLABSI Implementation Content

CUSP

CLASBI

Wash hands prior to procedure

Use maximal barrier precautions

Clean skin with chlorhexidine

Avoid femoral lines

Remove unnecessary lines

  • Educate on the science of safety
  • Identify defects
  • Assign executive to adopt unit
  • Learn from defects
  • Implement teamwork and communication tools
cusp clabsi intervention processes
CUSP CLABSI Intervention Processes

Individual Components

  • Planning/ orientation calls
  • Baseline data collection period for CLABSI and safety culture
  • Kickoff meeting
  • Monthly infection rate and team process data submission
  • Monthly content calls
  • Monthly coaching calls
  • Monthly feedback reports on outcome and process measures
  • Mid-course meeting
  • End-of-project meeting

Project spans two years and requires participation in:

  • 2-3 in-person meetings
  • 48-60 calls led by national project team
  • 24 internal meetings of implementation team
  • Monthly data collection, submission, and assessment (lessons learned/root cause analysis)
obstacles to evolving
Obstacles to Evolving
  • Proven initial model: Change distances project from proof method will work
  • Project databases: Stability justifies creating and building a robust national database
  • Evaluation: Simpler and cleaner to assess outcome of a single intervention
  • Project planning: Proposal submission process requires plan easier to execute than to modify
  • Budgets/Contracts: Executed agreements with subcontractors commit resources for specific tasks
  • Clarity: Change creates questions and confusion
lessons from two airplanes
Lessons from Two Airplanes

Change is difficult, risky, but absolutely essential for mass production (or a national rollout to succeed.

predictable evolutions in national qi campaigns
Predictable Evolutions in National QI Campaigns
  • Key challenge shifts from obtaining proof change is possible to achieving change in specific units.
  • Baseline problem level changes from 5 infections per 1,000 central line days to 2-3 infections per 1,000 central line days.
  • Goal changes from under 1 infection per 1,000 central line days to total elimination .
predictable evolutions in national qi campaigns13
Predictable Evolutions in National QI Campaigns
  • Participant expectations change from uncertainty of success despite effort to (over)confidence in success with minimal effort.
  • Participants change from innovators and early adopters to mid- to late-majority hospitals.
  • External environment changes from project as unique and innovative to project as one of many improvement activities in the area.
national qi campaign paradoxes
National QI Campaign Paradoxes
  • The more successfully a national QI campaign begins, the more pressure there will be for it to remain unchanged and the more need it will have to evolve quickly and substantially.
  • Nothing guarantees failure more than continued, unreflective reliance on the processes that first produced success.
implications for leaders of national qi campaigns and funding organizations
Implications for Leaders of National QI Campaigns and Funding Organizations
  • Proposal Evaluation
  • Budgeting
  • Goal Setting
  • Project Leadership
  • Operational Processes
  • Data Bases
  • Evaluation
implications for leaders of national qi campaigns and funding organizations key questions
Implications for Leaders of National QI Campaigns and Funding Organizations: Key Questions
implications for leaders of national qi campaigns and funding organizations key questions20
Implications for Leaders of National QI Campaigns and Funding Organizations: Key Questions
final thoughts
Final Thoughts
  • Critical to distinguish between essential success factors and processes for helping hospitals implement them.
    • Success factors for CUSP: CLABSI
      • Culture change that makes safety a priority and empowers every employee to hold every other employee accountable for safety
      • Operational changes that reduce infections
    • Processes likely to morph: Set of meetings and calls used to educate, motivate, and empower unit staff to implement CUSP: CLABSI.
final thoughts22
Final Thoughts
  • Critical to recognize inherent tensions in national campaigns.
    • Consistency & clarity vs. need to change
    • Strong national leadership vs. flexible local leadership
    • Design that supports strong, clean evaluation of impact vs. design that maximizes operational impact
    • Processes likely to morph: Set of meetings and calls used to educate, motivate, and empower unit staff to implement CUSP: CLABSI
  • More research and reflection required on how to make national campaigns successful and efficient (e.g. Scale Up & Spread Conference funded by AHRQ, Commonwealth Fund & others.
final thoughts23
Final Thoughts
  • Need to account for context in planning and executing a campaign:
    • Inevitable that parts of campaign will not take place in ideal context
      • Could be ideal when funded, less enthusiasm during implementation
      • Could be ideal at kickoff, but requires visionary funder that correctly times the trend
    • Need strategies for both directly influencing participants and for shaping the national environment to support campaign’s goals.
questions
Questions
  • About presentation:
    • Steve Hines

[email protected]

312-422-2607

  • About participating in CUSP: CAUTI or CUSP:CLABSI

[email protected]

646-678-4280

Disclaimer:

Although the CUSP:CLABSI project is funded by AHRQ and is being led by a partnership that includes Johns Hopkins University and the Michigan Health and Hospital Association, the opinions in this presentation are exclusively those of the presenter. Like an effective national campaign, these views are also likely to evolve over time.

ad