1. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Sustaining and Spreading surgical safety improvements with SUSP Mike Rosen, Ph.D. Liza Wick, M.D.

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

3. What are we sustaining and spreading? Armstrong Institute for Patient Safety and Quality 3 Adaptive CUSP Technical SSI’s

4. What are we sustaining and spreading? Comprehensive Unit based Safety Program (CUSP) 1.Educate staff on science of safety 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools Translating Evidence Into Practice (TRiP) 1.Summarize the evidence in a checklist 2.Identify local barriers to implementation 3.Measure performance 4.Ensure all patients get the evidence Engage Educate Execute Evaluate Reducing Surgical Site Infections Emerging Evidence Local Opportunities to Improve Collaborative learning Technical WorkAdaptive Work 4

5. Polling Question Armstrong Institute for Patient Safety and Quality 5 Tell us what you think: Do you plan on sustaining / spreading your surgical safety efforts? If so, what are your goals for sustaining surgical safety efforts in your organization. If not, why not? Type your ideas in the chat box as we go, and we’ll debrief later in the call.

6. Sustainment and spread of… Our successes reducing SSIs –Ensuring process changes and improved outcomes persist CUSP tools to other patient harm risks –Using the team you’ve built to address other problems CUSP tools to other service lines –Developing CUSP teams in other areas

7. Why worry about sustainment? What happens… –when the evidence changes? –with staff turnover? –when you shift focus to new areas? –when new initiatives come up?

8. What do effective teams look like? Effective teams… –Meet regularly –Have active surgical champions who partner with others –Have administrative support –Believe that progress can be made –Invent and reinvent ways to create engagement –Communicate frequently

9. Is your SUSP team ready for sustainment?: A quick self-assessment  We meet regularly with front line staff attendance  We have participation from all stakeholders including executive partners  We’ve built, implemented, and evaluated our SSI bundle  We’ve successfully learned from at least one defect per quarter  We know where (which system) to report future data  We regularly share data with front-line

10. Polling Question What aspects of your surgical safety improvement work, do you feel are most critical to sustain? (multi-select) –Training on the science of safety –Staff safety assessment (how will the next patient be harmed, and what can we do to prevent that?) –Learning from defects –Safety culture assessment and debrief (HSOPS) –Implementing tools to improve teamwork –Partnering with an executive leader –Sharing and learning with your peers in a collaborative setting –Other (type in chat box) Why? –type in chat box Which of the above do you feel will be most difficult to sustain? Why? –type in chat box

11. What sustainment strategies work? Sticking to a process for… –Small scale tests of change (e.g., pilots) –Measuring and making data driven decisions Continuous access to feedback –Review of meaningful patient outcome (and process) data Integrate surgical safety efforts with quality efforts –Reporting and accountability (e.g., committees, performance goals) –Training programs for all staff (e.g., orientations) –Make the surgical safety efforts your own—adapt language

12. What sustainment strategies work? Building organizational capacity –Ensure teams are multi-disciplinary –Continue building internal expertise in perioperative improvement –Increase frontline staff participation in process improvement –Safety improvement needs to be part of the normal workflow and culture Secure time and resources –Personnel and financial resources are needed to sustain this work –Support for data abstraction and analysis Align goals with the broader hospital and external requirements –Connect surgical safety efforts to hospital priorities

13. We’re ready to sustain, now what?  Re-administer staff safety assessment (2 question survey)  Complete learning from defects tool at least once quarterly and share results with frontline  Share stories  Orient all new staff on the science of safety training and to the SUSP team  Continue training staff on SUSP related skills  Continue involvement in state collaborative  Revisit “The right team mix”

14. Preview of Pre-Mortem For 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 Pre-Mortem handout and jot down responses

15. Polling Question How often would you like to have additional calls on sustainability topics over the next 6 months? –Every month –Every other month –1 or 2 more calls –Other (Describe in the chat box) What will be most helpful for sustaining your surgical safety efforts? –Ongoing state-based coaching calls –Affinity group-based calls (e.g., based on service line not geography) –Other ideas? Who would you like to hear more from about sustainability? –Peers at other hospitals –Hopkins, National Project Team (NPT)

16. Next Steps Next call on Tuesday, February 4 th at 4PM (EST) Report out on pre-mortem (Review pre-mortem worksheet) Review sustainment planning Armstrong Institute for Patient Safety and Quality 16