1. Engaging Senior Executives in SUSP Work Mike Rosen, PhD and Liza Wick, MD December 9 and December 11, 2013

2. Get Your Bearings The CUSP Toolkit: CUSP Manual Step 3 https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx Armstrong Institute for Patient Safety and Quality 2

3. Learning Objectives Distinguish between SCIP work and SUSP work from the executive perspective Identify common barriers to executive engagement in improvement work Identify successful strategies for engaging your executive in SUSP work

4. Surgical Care Improvement Project (SCIP) CMS National Impact Assessment of Medicare Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF. March 2012; 42.https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF

5. Colorectal SSI Rate by Quarter (NSQIP) 5 Baseline Year 1 Year 2 Year 3 SSI Rate: 27% SSI: 17% SSI Rate: 20% SSI Rate: 11%??

6. What do you think? (Poll) Do SCIP compliance and SSI reduction require different leadership approaches at the organizational level? Armstrong Institute for Patient Safety and Quality 6

7. THREE EXECUTIVE ENGAGEMENT STORIES Hear how real-world executives do SUSP work Armstrong Institute for Patient Safety and Quality 7

8. Revision of Laparoscopic GI Surgery Trays Problem: Lap tray had 137 instruments, and many open instruments set up for cases were never used Barriers: JHH Unionized Employees process open instruments. Contractor processes lap instruments. Intervention: Reduced lap tray to 54 instruments Impact: Fewer instruments to count and turnover saves money and time. Armstrong Institute for Patient Safety and Quality 8

9. Hidden Cost-Savings: Antibiotic Irrigation Problem: Frontline providers questioned the inconsistency in use of antibiotic irrigation between surgeons Barriers: Prominent surgeons believed in the utility of antibiotic irrigation Intervention: A literature review –No evidence to support use –Removed from hospital formulary Impact: $537,000/year savings on antibiotic irrigation Armstrong Institute for Patient Safety and Quality 9

10. Updating Preference Cards Problem: Equipment, supplies and/or instruments not available for cases Barriers: EPIC Rollout in JHHS, EPIC Optime Intervention: –Decreased number of DPCs –Removed argon from colorectal DPCs –4 colorectal cards (open/lap, anorectal, ileostomy reversal) Impact: Fewer errors, increased efficiency Armstrong Institute for Patient Safety and Quality 10

11. Executives’ SUSP work is unique, possibly even uncomfortable Armstrong Institute for Patient Safety and Quality 11 SUSP work is less prescriptive It entails more than EMR fixes –More problem solving and critical thinking –“You don’t know what’s coming”

12. The SUSP Executive partners with other senior leaders 12

13. Important Considerations for the Executive Partnership Surgeons have a lot of leverage in the organization. –Executive does not want to lose surgeon volume, especially if there are multiple competing hospitals in your area. Executive has many competing priorities. –You will need to be proactive about scheduling regular meetings with your executive. –Your team may need to make the case for meaningful executive participation in SUSP. 13

14. SUSP Partnership can be Mutually Beneficial Through SUSP, the executive has an opportunity to develop strategies for the whole organization. The executive can share successes broadly. There may be financial payoff by doing improvement work with engaged clinicians (instead of to them). 14

15. The senior executive can help lead the team to ensure: Is everyone clear on the goals, timelines, and mission? Is the necessary structure in place – people, roles, authority and responsibility? Are decision making, problem solving and conflict management processes clear? Are material resources in place – space, equipment, people, budgets? Are financial tracking mechanisms in place (CMS P4P implications)?

16. How to Engage Your Executive Clarify Asks –Tell the senior executive what you need (with data!) Use Executive Safety Rounds to solidify the team (bring data!) Increase the visibility of your senior executive Ensure an executive is assigned to each SUSP team and participates regularly in meetings Armstrong Institute for Patient Safety and Quality 16

17. Pre-work Helps Make Executive Safety Rounds Successful Schedule monthly executive safety rounds for the year –Add a time buffer Prepare the senior executive –Offer a tour of your perioperative units. –Discuss perioperative unit-specific information before the first executive safety rounds. Use the Executive Safety Rounds Kickoff Template to structure the meeting Armstrong Institute for Patient Safety and Quality 17

18. Executive Safety Rounds Kickoff Template: Make the most of your first safety rounds https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx Armstrong Institute for Patient Safety and Quality 18

19. Executive Safety Rounds Kickoff Template: Make the most of your first safety rounds Helps your team focus the meeting with your executive partner Prompts your team to prepare relevant info: –Safety culture survey results –The prioritized list of safety issues compiled from the Perioperative Staff Safety Assessment –Pertinent information about the unit that the senior executive may not know Armstrong Institute for Patient Safety and Quality 19

20. Step 1. Safety Culture Survey Composite Scores Share your Safety Culture Survey (HSOPS) scores with your senior executive. –You can copy the composite scores graphs from your HSOPS report. –Consider a safety culture ‘brief’, highlighting important points or culture score results that you’d like to bring to your senior executive’s attention. 20

21. Step 2. Collated Perioperative Staff Safety Assessment (PSSA) Responses Your team is administering the PSSA to your entire staff, and grouping responses by commonly identified defects. You can put that information in a table to help your senior executive get familiar with your clinical area’s safety priorities. –Consider building on staff’s suggestions for improvement with specific recommendations for your senior executive. 21

22. Step 3. Pertinent Clinical Area Information You can include a few bullet points or graphs with information about your clinical area that your executive may not know. Information may include staff turnover rate, number and type of surgical cases, safety event rates, surgical site infection rate, or other NSQIP data. 22

23. Executive Safety Rounds A Concrete Engagement Strategy Begin with a senior executive walk-through of the clinical area, led by a frontline clinician. Solicit collaboration with sit-down discussions that are open to all staff. Review identified safety issues together. The senior executive can help prioritize your perioperative units’ safety concerns. Armstrong Institute for Patient Safety and Quality 23

24. We’d like you to try a small test of change Pilot Executive Safety Rounds in your hospital Use the Executive Safety Rounds Kickoff Template Share your successes and challenges on your next state coaching call. We’ll be asking: –Have you scheduled your Executive Safety Rounds meeting? –What strategies have you used to engage your executive? 24

25. What questions do you have? Remember you have a support network –You can ask questions state coaching calls –You can contact the SUSP helpdesk 25

26. Project Call Evaluation https://www.surveymonkey.com/s/SUSP_Cohort4 Armstrong Institute for Patient Safety and Quality 26