Using CUSP as a Framework for Improving Patient Safety

1. Using CUSP as a Framework for Improving Patient Safety Steve Levy Director of Operations MHA PSO

2. Topics • Overview of the Michigan Health & Hospital Association collaborative team • What is the Comprehensive Unit-based Safety Program (CUSP)? • CUSP as a framework for improving patient safety • How the MHA PSO collaborates with MHA Keystone using CUSP to improve patient safety in the operating room: process and results

3. The Team • Data Warehousing • Expertise • Patient Safety Resources • Data Analytics • Coordination of resources • Expertise • Collaborative management • Interventions • Expertise Vision: Health care that is free of harm

4. MHA Keystone Center Michigan Collaboratives

5. Collaboration MHA PSO • Address patient safety • Enhance coordination of care • Work towards healthy unit culture • Improve communication and teamwork MHA Keystone Data analytics Psychological Safety Education & training Tools to improve patient safety

6. CUSP • The Johns Hopkins Comprehensive Unit-based Safety Program • An Intervention to learn from mistakes and improve safety culture • Designed to integrate safety practices into a unit • The framework for improving patient safety for MHA Keystone collaboratives • 5 step process Pronovost J Patient Safety 2005

7. CUSP Steps • Step 1: Safety Culture Assessment • (& Reassessment) • Step 2: Science of Safety Training • Step 3: Staff Identify Defects • Step 4: Executive Partnership • Step 5: Learning from Defects/Tools Adapted from Pronovost J Patient Safety 2005

8. Step 1: Base Line Safety Culture Assessment • What: establish a baseline measure of Culture of Safety at the unit level • Goal: assess the level of importance a unit/clinical area places on safety and elicit caregiver attitudes • MHA PSO Role: generate a comprehensive picture of the unit/hospital through adverse event and cultural data analysis

9. Cultural Scores for MHA Keystone: Surgery 2008 - 2011 Avg. % Positive Facilities = 31

10. Cultural Domain Scores for MHA Keystone: Surgery 2008 - 2011

11. Adverse Events by Quarter for MHA Keystone: Surgery 2009 No. of Adverse Events 24 19 18 14 Q1 Q2 Q3 Q4 Facilities = 35

12. Step 2 Educate Caregivers About Patient Safety • What: Science of Safety Training • Goals: • inform staff about the magnitude of the patient safety problem • provide a foundation for investigating safety hazards/defects from a systems perspective • highlight how they can make a difference in care safer • MHA PSO Role: provide data support, literature review and “Evidence Library” of research from ECRI Wrong Site Surgery Tool Kit

13. Evidence Library • Standards/Guidelines • ECRI Institute Resources • General Literature Review • Lessons Learned

14. Step 3 Identification of Defects • What: hospital staff identify defects • Goal: tap into the expertise and knowledge of frontline staff to identify current risks to patient safety • MHA PSO Role: provide a “safe” environment to encourage reporting of defects, help identify and prioritize issues

15. Adverse Event Contributing Factors for MHA Keystone: Surgery 2009 No. of Factors 79 Facilities = 35 Factors = 326 29 29

16. Adverse Event Contributing Factors vs. Patient Safety Cultural Domains MHA Keystone: Surgery 2009 Surgical Adverse Event Contributing Factors Communication Training of Staff Avail. of Information n=78 n=29 n=29 Avg. % Positive Safety Climate Team Climate facilities=31 Cultural Domain

17. Step 4 Executive Partnership • What: partners a senior hospital executive with a unit • Goal: bridge the gap between senior leaders, middle management and frontline caregivers. Build the “business case” to executive • MHA PSO Role: support executive understanding of significance of issues at unit level through data and research

18. Business Case Measures How often did we find surgical checklist discrepancies? • OR Schedule Discrepancy • Briefing/Debriefing Discrepancy • Consent Discrepancy • Documentation Discrepancy

19. Step 5 Learning From Defects and Applying Tools • What: provides tools to improve teamwork, communication, and other systems of work in the unit • Goal: learn from our mistakes, improve teamwork and communication • MHA PSO Role: provide patient safety tools and resources to supplement the CUSP tools

20. Improvement ToolsMHA PSO Contribution • ECRI Wrong Site Surgery Tool Kit • Business Case • Evidence Library • Investigations • Preventions • Measuring/Monitoring • Training • RCA reviews • Webinars • Annual patient safety symposium • Safe Tables

21. Improvement ToolsKeystone Contribution • Learning From Defects Tool • Briefings/Debriefings • Shadowing • Staff Safety Assessment • Team Check Up Tool (with PSO) • Patient Safety Score Card (with PSO)

22. Results • The combination of MHA PSO and MHA Keystone resources greatly improves the ability to make a positive and sustainable impact on patient safety • MHA Membership (Hospitals) understand and support the roles