Building Your CUSP Team Part I Michael Rosen, PhD August 28, 2012 Armstrong Institute for Patient Safety and Quality Conference Number(s): Participant Code:

On Boarding Call Schedule – Tuesdays 2:00 Program Introduction August 21, 2012 Building CUSP team – August 28, 2012 Science of Safety – September 4, 2012 CUSP Part 2 – September 11, 2012 VAP Evidence – September 18,2012 Daily Goals Review – September 25, 2012 Early Ambulation– August /30/2012 CUSP Comprehensive Unit Based Safety Program; VAP Ventilator Associated Pneumonia

Learning Objectives Describe the importance of your CUSP team Develop a strategy to build a successful team Define roles and responsibilities of team members Identify characteristics of successful teams and barriers to team performance 3

An overview of the CUSP team

The Armstrong Institute Model to Improve Care Comprehensive Unit based Safety Program (CUSP) 1.Educate staff on science of safety 2.Identify defects 3.Recruit executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools Translating Evidence Into Practice (TRiP) 1.Summarize the evidence 2.Identify local barriers to implementation 3.Measure performance 4.Ensure all patients get the evidence Engage Educate Execute Evaluate Eliminating Ventilator Associate Pneumonia Emerging Evidence Local Opportunities to Improve Collaborative learning Technical WorkAdaptive Work

The CUSP Team Understands that patient safety culture is local Composed of engaged frontline providers who take ownership of patient safety Includes staff members who have different levels of experience and perspectives Meets regularly (weekly or at least monthly) Has adequate resources including protected time –2 to 4 hours per week for a team leader, surgeon, anesthesia, nurse, and infection preventionist

Team Performance Outputs Performance Attitudes Behaviors Inputs Environment Hospital & Unit Context Team Composition Task Design Processes Inside Team Outside Team Team Traits

CUSP Team Members 8 Physician champion Nurse champion Project lead/ unit champion Respiratory Therapist Infection Control Executive Partner Frontline staff Nurse Educator ICU Nurse Manager Pharmacist Hospital Patient Safety Chief Quality Officer Staff from Safety, Quality or Risk Mgmt Office

Team Composition A team leader Champions (nurse and physician) Local “opinion leaders” People with diverse opinions 9

Team Composition Someone outgoing Someone who sees the big picture Someone detail-oriented Everyone dedicated 10

Successful teams have… Reliable Processes –Education and engagement activities –Communication –Leadership support/buy-in –Conflict (and conflict resolution) 11

Successful teams have … (cont.) Norms –Valuing individual contributions –Cohesion (team unity) –Goal agreement –Self-assessment of knowledge /skills –Participation of team members Role clarity 12

FORMING YOUR CUSP TEAM

Engage Core CUSP Team Members 14 Physician champion Nurse champion Project lead/ unit champion Respiratory Therapist Infection Control Executive Partner Frontline staff Nurse Educator ICU Nurse Manager Pharmacist Hospital Patient Safety Chief Quality Officer Staff from Safety, Quality or Risk Mgmt Office

Tips for Engaging Physicians on the CUSP Team 1.Identify physician leaders 2.Create a forum for this role 3.Listen to physician concerns 4.Develop plans to address concerns 5.Reward physician leaders 6.Create a vehicle for communication 7.Develop a plan for communications

Physician Engagement Strategies Create a Compact (an Agreement) with management –Clearly define what is expected of physicians –Review performance regularly 16

Example Physician Champion Compact Hospital will provide support for percent of physicians’ time In return, physician will do the following: –Monitor and improve quality Implement CUSP and VAP interventions Hold regular meetings with team Involve other members of Medical staff in quality Report VAP rates and learning from defects results to senior leaders and board 17

Example Physician Champion Compact Further, physician will do the following: –Work with hospital to clarify what will be measured, who will measure it, and who will produce reports Meet quarterly to discuss progress 18

Tips for Scheduling Your Meetings Incorporate CUSP meetings into ongoing educational activities to ease scheduling challenges –Regularly scheduled nurse training –Grand rounds for physicians –Invite RNs to joint grand rounds Create incentives for participating –Educational credit for participation

Establishing clear roles and responsibilities on your CUSP team 20

Action Items Form your team with an appreciation of the importance of WHO is on the team Complete the CUSP Team Membership Form Plan to attend Part II of Building your CUSP Team

Questions or Comments? Armstrong Institute for Patient Safety and Quality 22

Contacts – Karol G. Wicker, MHS Senior Director, Quality Policy & Advocacy Maryland Hospital Association –Mary Catanzaro RN BSMT CIC Project Manager HAIs Hospital and Healthsystem Association of Pennsylvania 23