1. Hawaii Surgical Unit Safety Program: The Journey Begins with the Comprehensive Unit-Based Safety Program May 21, 2013 Della M. Lin, M.D. dlinmdconsult@yahoo.com Hawaii Safer Care SUSP

3. “the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical problems.” Ron Heifetz 3

5. Comprehensive Unit-based Safety Program (CUSP) Assign executive to adopt unit Educate staff on science of safety Identify defects Learn from one defect per month/quarter Implement teamwork tools Pronovost J, Patient Safety, 2005

6. It Takes Three! Robust Data Implementation of Evidence-Based Measures Effective Safety Culture

7. Hawaii CUSP-CLABSI collaborative

8. Hospital Acquired Infections (CLABSI) SIR scores: CMS Hospital Compare PR 1.58 MS 0.91 MD 0.87 ME 0.84 LA0.81 RI 0.76 MH 0.76 TN 0.72 AL 0.72 MT 0.69 SC 0.67 NJ 0.67 WV 0.66 NY 0.66 DC0.63 KS 0.33 MI0.32 SD0.24 HI0.17 IL0.50 WY0.49 VT0.48 OR0.47 PA0.46 MO0.46 ID0.45 OH0.44 AR0.44 WA0.42 IN0.41 MN0.38 DE0.37 ND0.37 AK0.35 VA0.62 NE0.59 OK0.58 GA0.58 WI0.55 CA0.54 WI0.54 UT0.54 CO0.53 TX0.52 NM0.52 NC0.51 IA0.51 Fl0.51 MA0.50 Accessed 8/20/2012 http://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/HospitalQualityInits/HospitalCompare.html

9. “During the 36-month study period, the overall CLABSI rate was reduced by 82%... …Importantly, the tools were not viewed as simple technical interventions but were instead designed as interventions with an adaptive component that would shape a culture of safety.”

10. SUSP Technical – Practices to Prevent Harm Evidence Based Practice 1. Audit Tools Education on the Evidence 1. Presentation of evidence 2. Fact Sheet 3. Cost Estimator 4. Summary of Professional Organization Recommendations 5. Annotated bibliography Implementatio n/ Sustaining 1.Checklist 2.Policy / Procedures 3. Protocol s 4. Monitoring 6. Feedback Adaptive (CUSP) Science of Safety 1. Science of Safety presentation 2. Attendance sheet Staff Identify Defects 1.Staff Safety Assessment form 2.Identifying Hazards presentation Senior Executive Partnership 1. Education 2. Briefings Learning from Defects 1. LFD toolkit 2.RCA of each incidence Implement Tools for Teamwork and Communication 1. Surgical Safety Briefing 2. Huddles 3. Debriefing 4. Shadowing 5. Handoff Tool 6. TeamSTEPPS Tools Assemble a SUSP team, Partner with a Senior Executive; Baseline Data Quality Improvement Tools 1. PDCA 2. Lean/Six Sigma 3. Reliable System Process 4. TCAB 5. Other

11. Comprehensive Unit-based Safety Program (CUSP) Assign executive to adopt unit Educate staff on science of safety – Acknowledge safety is a property of a system – Standardize what you can – Use safe design principles Identify defects Learn from one defect per month/quarter Implement teamwork tools

12. What makes CUSP unique? Pearls for the CUSP approach – Horizontal: Comprehensive UNIT-BASED approach – Vertical: Intentional Executive Leadership role and participation – Trans Dimensional: Multidisciplinary Team Tools for ensuring diverse and independent input – Adaptive: Leverage tools that promote behavior change to model mental model change 12

13. What will you do differently? How will you do it differently?