Results of Quarterly Team Update Interviews Kisha Ali, MS Donna Farley, PhD, MPH August 8, 2013

Quarterly Team Update Tool 1 ICU collaborative developed the Team Checkup Tool (TCT) in 2005 during the MHA Keystone Designed to close the gap between hospital executives and frontline teams Purpose is to help collaborative or project, hospital, and team leaders identify and work with teams to provide needed training, resources, or other aids 2

Quarterly Team Update Tool Quantitative results focused on 4 measures: 1. Training on patient safety 2. Implementation of CUSP tools 3. Leadership commitment and support 4. Barriers to progress 3

Measure 1. Training on Patient Safety Question 1: Since you began participating in the project, how many of your staff have viewed a video or presentation on the science of safety? - None/few - Less than one half - One half or more - Almost all/All Question 3: Is a patient safety presentation now part of new staff orientation for your unit? - Yes/No 4

Measure 1: Results from Training on Patient Safety 5 Fig 1. Percentage Distribution by Number of Patient Safety Training Actions Taken

Measure 2: Implementation of CUSP Tools Question 18: What CUSP tools are you implementing? Responses: - Shadowing - Morning briefings - Daily goals checklist - Culture checkup tool - Learning from defects tool - Barrier identification and mitigation - Observing rounds (fly on the wall) - Structured communications 6

Measure 2: Results from Implementation of CUSP Tools 7 Fig 2. Percentage Distribution by the Number of CUSP Tools Used

Measure 3: Leadership Commitment and Support Question 21: Is the organizational leadership taking the following steps to reinforce its support for the work? Checklist items: 1. Ensures training on science of safety 2. Monthly meeting with VAP team 3. Makes EVAP an organization-wide goal 4. Disseminating learning from defects lessons 5. Provides protected time to VAP team leaders 6. Reviews VAP rates quarterly at board meetings 8

Measure 3: Results from Leadership Commitment and Support 9 Fig 3. Percentage Distribution by the Number of Leadership Support Actions Taken

Measure 4: Barriers to Progress Question 29: In the past 6 months, how often did each of the following slow your CUSP team’s progress in implementing the CUSP and VAP interventions? Responses classified into 4 categories: 1.Leadership support issues 2.Team skills and cohesion issues 3.Stakeholder push ‐ back issues 4.Workload and time issues 10

Measure 4: Results from Barriers to Progress 11 Fig 4. Percentage Distribution by the Number of Barriers Reported as Frequent or Always

Measure 4: Results from Barriers to Progress 12 Fig 5. Barriers Reported as Being Frequent or Always All units (N=43)MD units (N=23)PA units (N=20) Barrier Percent of Units Barrier Percent of Units Barrier Percent of Units Competing priorities58.1Competing priorities47.8Competing priorities70.0 Data collection burden48.8Data collection burden43.5Data collection burden55.0 Not enough time39.5Not enough time39.1Staff turnover on unit45.0 Data system problems32.6Data system problems26.1Confusion on CUSP40.0 Staff turnover on unit27.9Leader support - exec13.0Not enough time40.0 Leader support - MDs18.6Leader support - MDs13.0Data system problems40.0 Confusion on CUSP18.6Staff turnover on unit13.0Leader support - MDs25.0 Poor buyin- MD staff16.3Knowledge of evidence8.7Turnover CUSP team25.0 Turnover CUSP team14.0Poor buyin- MD staff8.7Poor buyin- MD staff25.0

Measure 4: Results from Barriers to Progress 13 Fig 6. Areas of Success - Lack of Barriers Reported as Being Frequent or Always All units (N=43)MD units (N=23)PA units (N=20) Barrier Percent of Units Barrier Percent of Units Barrier Percent of Units Lack team agree on goals2.3Turnover CUSP team0.0Poor team teamwork0.0 Poor buy-in - nurse staff2.3Poor buy-in - nurse staff0.0Poor buy-in - nurse staff5.0 Poor team teamwork4.7Leader support - nurses0.0Leader support - nurses5.0 Knowledge of evidence4.7Little autonomy0.0Lack QI skills5.0 Leader support - nurses4.7Lack QI skills0.0Leader support - exec10.0 Lack QI skills7.0Confusion on CUSP0.0Little autonomy10.0 Little autonomy9.3Poor team teamwork4.3Poor buy-in - other staff15.0 Poor buy-in - other staff9.3Poor buy-in - other staff4.3Knowledge of evidence15.0

Conclusion Currently we have conducted 43 Quarter 1 interviews Process works well Yet to begin our qualitative analysis of these interviews – should yield interesting results As we move forward, more Quarter 1 reports being scheduled, as we move into Q2 interviews 14

Reference 15 1.Lubomski LH, Marsteller JA, Hsu YJ, et al. The Team Checkup Tool: Evaluating QI Team Activities and Giving Feedback to Senior Leaders. Joint Comm J Qual Pt Safety. 2008; 34(10):