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

4. MHA Keystone Center Michigan Collaboratives Collaborative Participating Hospitals Keystone: ICU77 Keystone: Hospital-Associated Infection120 Keystone: Surgery104 Keystone: Obstetrics60 Keystone: Gift of Life76 Keystone: Emergency Department66 MI STA*AR (Rehospitalization Project)27

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

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 Facilities = 35 Q1 Q2Q3Q4 No. of Adverse Events 14 24 19 18

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 Facilities = 35 Factors = 326 No. of Factors 79 29

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

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 Tools MHA 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 Tools Keystone 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