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© 2009 On the CUSP: Lessons from the Michigan Keystone ICU Project Going where no state had gone before…
© 2009 Learning Objectives To become familiar with a successful large-scale improvement project: Keystone ICU To understand some of the Lessons from that project To think about how those lessons might help in your local quality and patient safety improvement efforts
© 2009 Keystone ICU AHRQ:“Patient Safety Matching Grant” 2003-2005 – Johns Hopkins Quality & Safety Research Group and Michigan Health & Hospital Association Keystone Center Over 100 intensive care units (77 hospitals) – Implemented The Comprehensive Unit based Safety Program “ CUSP” Statistically significant improvement in safety and teamwork climate Implemented evidence-based interventions to reduce catheter related blood stream infections in ICUs Statistically significant reduction in CLABSI (66% reduction)
© 2009 Understand the differences between leadership and authority: Senior leader involvement is important – CUSP executive early builds the support system Leadership however, is a skill not linked to “position” Formal and informal leaders are both important Invite all interested individuals to be part of the improvement team Goal: Cultivate Leaders
© 2009 Recognize technical versus adaptive work Technical work is knowledge based and focuses on CONTENT – Defining the project, selecting measures, defining variables and data collection methods, analyzing data and preparing reports are all TECHNICAL activities and most efficiently managed at a central level Adaptive work is behavior, or values based and focuses on CONTEXT – Implementing interventions, respecting wisdom of the front- line, developing a plan that addresses both “head and heart” must be managed at a local level Goal: Get the Technical and Adaptive Work Right
© 2009 Strive to find the sweet spot Interventions with the strongest evidence – (lowest number needed to treat) Interventions with the fewest implementation barriers Minimize burden of data collection – Sacrifice on quantity, not quality of data Goal: Find a Balance What is both Scientifically Sound and Feasible?
© 2009 Database Design is Critical Match project goals, objectives and database design in the beginning – Clearly defined goals and objectives – Written plan to measure progress toward goals – Estimate of baseline performance – System for measuring performance Critical to get reports back to frontline staff as well as administrative leaders Transparency Goal: Begin with the End in Mind
© 2009 Minimize the bias in data collection Rigor of QI studies is often limited Methods to minimize bias include: – Create a manual of operations and data dictionary – CDC has standard definitions; we need to use them – Pilot test data collection forms – Create a data quality control plan Process to train data collectors & evaluate reliability Imbed range checks in the database Critical to minimize missing data – Greatest risk to validity of effort is poor data Goal: Strive to minimize bias; be transparent where it exists
© 2009 Reduce the quantity not the quality of data Be realistic about the burden of data collection Appreciate the challenges of measure selection – Face validity – Physician engagement Acknowledge the importance of complete data – Biased data is worse than no data Goal: Commit to data that is meaningful, feasible and answers the question: Is Care Safer?
© 2009 Link culture and clinical outcomes Creating a culture of safety and teamwork may enhance ability to implement clinical interventions May be a relationship between unit climate and sustainability of improvement The Comprehensive Unit-based Safety Program (CUSP) provides structured tools to help achieve culture improvement (adaptive change) Goal: Learn from linking culture and clinical data
© 2009 Stay focused on original aims Scope creep can kill a project – Enthusiasm to improve care – Frustration with challenges of project implementation – Deplete resources – Diffuse energy No new interventions until achieve goal of “current” intervention Goal: clear, consistent focus on original aims
© 2009 Keep a laser sharp focus on patients Hospital, clinician and unit “perspectives” are unique – Conflicts WILL arise Commitment: harm is untenable – Communication tools help bridge the gap – Address gaps between spoken support and actions Patients are the north star Goal: What is best for patients guides the work
© 2009 Expect the project to stall at intervals Every project stalls – Important to listen for the “music beneath the words” Listen deeply – Respond honestly Most people don’t fear change; they fear loss – Surface issues; address fears; then move forward Change happens “at the edges” – Understand that timeline may need to flex in order to meet project goals Goal: Look at “Pauses” as an opportunity for deep learning
© 2009 Innovate to improve Need methodologic rigor and strict data management in QI/Patient Safety studies All teams are capable of both in a partnership model (central technical work/local adaptive work) Data collection that is narrow but deep provides important knowledge for the industry Studies that are poorly designed and implemented waste resources and mislead caregivers and the public Goal: Support QI activities that are efficient, effective, scientifically sound
© 2009 Action Items Commit: Harm is not tenable Create a team Assign responsibilities Ensure you have a system for data collection Create a system to regularly share project data Participate on project calls Implement interventions Share experiences with other project teams
© 2009 References Goeschel CA, Pronovost PJ, Harnessing the Potential of Improvement Collaboratives: Lessons from the Keystone ICU Project. Advances in Patient Safety: New Directions and Alternative Approaches. AHRQ 2008 Pronovost P J, Berenholtz S, Goeschel CA, Improving the Quality of Measurement and Evaluation in Quality Improvement Efforts, American Journal of Medical Quality, Vol 23, No 2. March/April 2008 Goeschel CA., Bourgault A, Palleschi M, Posa P, Harrison D, Tacia L, et al. Nursing Lessons from the MHA Keystone ICU Project: Developing and Implementing an Innovative Approach to Patient Safety. Critical Care Nursing Clinics of North America. Vol 18. No 4. Dec. 2006. 481-492 Needham DM, Sinopoli DJ, Dinglas VD, Berenholtz SM, Korupolu R, Watson SR,Lumbomski L, Goeschel C, Pronovost PJ. Improving data quality control in quality improvement projects. International Journal for Quality in Health Care. 2009. In press.
© 2009 On the CUSP: STOP BSI Overview of STOP-BSI Program.
Improving ICU Care Through Teamwork
Toward Eliminating Central Line Associated Blood Stream Infections.
© 2009 On the CUSP: STOP BSI Senior Leadership of Quality and Safety Initiatives in Health Care.
Learning Objectives 2 2 Explain the role of the senior executive in addressing technical and adaptive work Identify characteristics to search for when.
Staff Safety Assessment 1. Learning Objectives To understand Step 2 of CUSP:Identify Defects To understand how to Implement the Staff Safety Assessment.
Improving Care Through Technical & Adaptive Work Chris Goeschel RN MPA Director, Patient Safety &Quality Initiatives JHU Quality & Safety Research Group.
CSTS: The Cardiovascular Surgical Translational Study Senior Leadership of Quality and Safety Initiatives in Health Care Peter J. Pronovost, MD, PhD The.
Learning Objectives Define roles and responsibilities of team members
Who We Are ~Where We are Going. Slide 2 Workshop Objectives Describe the purpose and vision of the ICU Safe Care Initiative/Comprehensive Unit-Based Safety.
Using CUSP as a Framework for Improving Patient Safety Steve Levy Director of Operations MHA PSO.
The Comprehensive Unit-based Safety Program (CUSP)
© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Taking Patient Safety to the Next Level Peter Pronovost, MD, PhD 1.
Senior Leader Engagement AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 2: Senior Leader Engagement.
CUSP 4 MVP – VAP Quantitative Implementation Assessment 1: Aggregated Results Kisha Ali, MS Mayo Levering, BS September 2, 2014.
Small and Rural Critical Access Hospitals July 19, 2011.
The Johns Hopkins Comprehensive Unit-based Patient Safety Program (CUSP) Peter Pronovost, MD, PhD, Johns Hopkins Univeristy.
Disclosures Nothing to disclose No discussion of “off-label” use of medications.
Moving Beyond the Horizon: Where are we going? How will we get there? Chris Goeschel RN MP MPS ScD (candidate) October 30, 2008
Small Rural/CAH Learning Community Meeting May 23, 2012 Denise Flook, RN, MPH, CIC HAI Collaborative Lead Vice President, Infection Prevention/Staff Engagement.
© 2009 On the CUSP: STOP BSI Nurse Empowerment Christine A. Goeschel RN MPA MPS ScD (candidate) Tennessee Center for Patient Safety December 2, 2009.
CSTS Staff Empowerment Christine A. Goeschel ScD MPA MPS RN.
Patient Safety Leadership Peter Pronovost MD PhD Professor, Schools of Medicine and Public Health Director, JHU Quality & Safety Research Group.
A Team Members Guide to a Culture of Safety
10 years after “To Err is Human” An RCA of Patient Safety Research? Peter Pronovost, MD, PhD.
AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 3: Staff Empowerment.
On the CUSP: STOP BSI Physician Engagement. Immersion Call Overview 1.Project overview 2.Science of Improving Patient Safety 3.Eliminating CLABSI 4.The.
Aim: Advance the adoption of proven strategies to improve the reliability, safety and quality of care received by patients in Tennessee hospitals.
Nurse Empowerment On the CUSP: Stop BSI
1 Reducing Healthcare Associated Infections (HAI): Barriers and Challenges MHA Keystone Center for Patient Safety and Quality (MHA Keystone) Chris George,
Learning Objectives Review the impact of errors and patient harm and the underlying causes of errors Show how CUSP supports other quality and safety tools.
Physician Engagement. Learning Objectives To relate what is meant by physician engagement To discuss strategies at management and staff levels to enhance.
© 2009 On the CUSP: STOP BSI Physician Engagement.
© 2009 On the CUSP: STOP BSI The Comprehensive Unit-based Safety Program (CUSP): An Intervention to Learn form Mistakes and Improve Safety Culture.
Wednesday 10 June 2015 Carrie Marr Executive Director Organisational Effectiveness WSLHD Mobilising People and Leading Sustainable Change.
Peter Pronovost, MD, PhD Johns Hopkins University
The Team Check-up Tool. Slide 2 Learning Objectives To understand the tool we use to: – Describe the anticipated activities of your ICU quality improvement.
Building Your CUSP Team Part I Michael Rosen, PhD August 28, 2012 Armstrong Institute for Patient Safety and Quality Conference Number(s):
Leadership for Healthcare Excellence The Power of Boards Healthcare Trustees of Montana Mountain – Pacific Quality Health Barbara Balik, RN, EdD May 25,
Sean Berenholtz, MD MHS FCCM September 20, 2011 at 2ET/1 CT/12 MT/11 PT Ventilator Associated Pneumonia Prevention CLABSI Supplemental Call Series.
Upon completion the participant will identify and list steps to implement The Comprehensive Unit-based Safety Program (CUSP) and patient care bundles.
Insert name of presentation on Master Slide Leadership and Safety Climate March 18, 2008 Presenter: Sue Gullo, RN,MS.
© 2009 On the CUSP: STOP BSI Nurse Empowerment.
Partnering for Quality Creating Reliability for Healthcare Peter Pronovost, MD, PhD Johns Hopkins University.
Healthy Work Environment Ferris State Nursing 320 Group Presentation Kevin Doan, Maira Perez, Amy Lewis, Bethany Hesselink, and (Kyle) Kurt Freund.
A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association September 20, 2015 Executive Briefing Drawn.
Primary Care Improvement Infrastructure: The Role of Practice Facilitation Michael L. Parchman, MD MPH MacColl Center for Health Care Innovation AHRQ Annual.
ICU Safe Care Initiative/CUSP October 5, :00 am – 3:30 pm.
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