1. Sustaining and Spreading Surgical Safety Improvements with SUSP Mike Rosen, PhD Elizabeth Wick, MD ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

2. Polling Question #1 What is your current role? Surgeon Quality improvement practitioner Infection preventionist OR nurse OR technician Anesthesiologist OR manager Other

3. Objectives Define sustainment and spread Determine if you are ready to sustain Plan key actions for sustainment Prioritize needs for successful sustainment

4. Sustainment is… What you do to continue to build on your successes How you persist in your efforts to change culture and improve safety When you apply the process of surgical safety improvement efforts to new challenges

5. Adaptive or Technical? Adaptive CUSP Technical SSI’s

6. Why worry about sustainment? Recidivism is not pretty Failure rates Risks to sustaining progress – Staff turnover – Overlying priorities – Organizational changes

7. Definition of Spread 1 “Spreading takes the process from the narrow, segmented population(s) or group(s) and broadens it to include all the population(s) or group(s) that will use the process.” “Formalizing a process provides a reference to others; those new to the organization and those in the organization needing clarity about the specifics of the process.”

8. Polling Question #2 How ready are you to sustain? On the previous slide, how many of the boxes could you check? 0-1Not so ready yet 2-3We are still implementing 4-5We are close 6+Ready to sustain our progress

9. What do effective teams look like? Effective teams have: – Regular meetings – Active surgical champions who partner with others – Executive / Leadership support – Believe that progress is possible – Invent ways to create engagement (and then reinvent more ways) – Frequent communication

10. What sustainment strategies work? Stick to formal processes – Test changes on small scale first – Measure and make data-driven decisions Maintain access to continuous feedback – Require current data to validate progress

11. What sustainment strategies work? Secure time and resources – Formalize job responsibilities for SUSP and patient safety improvement—protected time for doing QI work – Dedicated financial resources and personnel – Make data support available Take care of your team – Plan for team growth and turnover – Offer highly engaged team members professional development opportunities

12. We are ready to sustain: Now what?  Re-administer Perioperative Staff Safety Assessment (2 question survey) every 12-18 months  Complete Learning From Defects (LFD) tool at least once quarterly  Share results and stories with frontline staff  Orient all new staff to the Science of Safety  Continue updating staff on SUSP activities  Continue collaborative activities  Revisit the “right team mix” and augment needs as team and projects evolve

13. Preview of Pre-mortem Looking ahead to the next session- Imagine that your teams’ gains in technical and adaptive work have slipped away. You’re back where you began. Why? List all the reasons you can that would result in loss of the gains you’ve made in SUSP. Review the CUSP Pre-Mortem Tool and jot down responses

14. Resources Look for these resources on the SUSP Project Site Perioperative Staff Safety Assessment (PSSA) Learning from Defects through Sensemaking (LFD) Tool CUSP Pre-Mortem Tool URL: https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspxhttps://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx URL: https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspxhttps://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx

15. Remember, we are here to help!