1. Assessing Patient Safety Culture and Navigating the CUSP 4 MVP-VAP Portal

2. Agenda Section I Mindfully understanding and developing safety culture Section II How do I use the HSOPS App as a survey coordinator to collect survey data What do survey participants see? How do I use the HSOPS App to upload previously collected survey data 2

3. Mindfully understanding and developing safety culture Section I 3

4. 4 Technical Work Adaptive Work Key concepts: Adaptive and Technical Work Sweet Spot

5. Mindfully manage and create the culture you want to see in your work area Bad habits develop when culture is ignored or not actively managed –We often drift, rather than nose dive into failure Being mindful of your work area’s culture helps fight the change paradox: –“The very things that make a new practice easy to implement also reduces the conscious reflection needed to implement it” (Gondo & Amis, 2013) 5

6. A “culture of safety” must be mindfully managed Culture is not static The most effective teams, work areas, and organizations are those which mindfully manage their culture of safety –They invest effort in understanding their culture –They define a shared vision for what their “ideal” culture of safety looks like –They applaud behavioral examples that embody or demonstrate this “ideal” culture of safety 6

7. The Armstrong Institute Model to Improve Care

8. CUSP & Safety Culture We ask that you measure safety culture at the start of this project –Provides a baseline to diagnose barriers and facilitators that can impact improvement efforts –Then will be re-measured 12 months following start of improvement efforts Use reliable and valid survey instrument –Hospital Survey on Patient Safety (HSOPS) CUSP is the intervention that you will use to help you improve culture results 8 CUSP 4MVP-VAP & Safety Culture: Overview

9. Do I have to upload or collect HSOPS data to participate in this project? No –No formal requirement to collect fresh HSOPS data or to upload previously collected data to the CUSP 4MVP-VAP data platform BUT! Safety culture data is a value-add for your improvement work… –Helps diagnose areas where culture might be hindering reliable use of evidence-based practices –Can help to understand why clinicians and staff are engaged (or not engaged) in safety efforts 9

10. Two Options for HSOPS 10

11. 11 How? Using the Online HSOPS App https://armstrongresearch.hopkinsmedicine.org

12. Survey coordinators will use the HSOPS app to… 1.Collect fresh HSOPS data or upload previous data –Email –Weblink –Upload excel file of previous data 2.Check on the response rate for their work areas –Goal = 60% response rate –Stretch goal = 80% response rate or higher 3.Download a.pdf report that summarizes survey results for their work area(s) –Reports will be available after the survey closes –Share and debrief results with teammates to meaningfully inform & guide improvement efforts 12

13. CUSP 4MVP-VAP & Safety Culture: HSOPS Details Important dates: –Baseline survey period opens: Wed, February 26, 2014 New survey responses can be collected or existing (formatted) excel file can be uploaded –Baseline survey period closes: Wed, April 23, 2014 @ 12 noon EST After this date/time team members can no longer take the survey online and no previous data can be uploaded 13

14. Comprehensive Unit-based Safety Program for CUSP4MVP – VAP HSOPS 14 Leveraging the MedConcert Social Enterprise Platform to Scale and Spread Safety and Quality Improvement Section II

15. When Armstrong opens a new cycle for data collection for HSOPS, the Network Administrators will receive an email notification. Network Administrators can click the link in the email to start administering the survey. The link in the email will direct Network Administrators directly to the My Tools Page. CUSP4MVP-VAP HSOPS New Data Collection Cycle Notification

16. Home Page Site can be accessed directly at: https://armstrongresearch. hopkinsmedicine.org https://armstrongresearch. hopkinsmedicine.org Option to login on or browse. Some pages only available with log-in The “Return to Armstrong Institute – Home” will take you back to the Armstrong Institute’s homepage Clicking on Project will take you to the Project Home Page

17. My Projects Shows all the available projects and will highlight the one(s) you are participating in You will be prompted to login before accessing this page Clicking on the project will take you to the VAP Project page Mary Schmidt

18. Tools that Focus on Eliminating Ventilator- Associated Pneumonia CUSP4MVP-VAP Home Page

19. CUSP4MVP-VAP My Tools Page Ability to Search by Tool Allows you to quickly access various tools your network(s) are registered for. Coordinating Entities will have the ability to view Tools registered to their Children networks. Mary Schmidt CUSP4MVP-VAP Test Network

20. Viewing for CUSP4MVP-VAP as Mary Schmidt Mary Schmidt Manage/View CUSP4MVP-VAP National Tools CUSP4MVP-VAP Project Page Displays your data entry tools Your access to a tool is determined by your role - whether you are a member or an administrator. For example, only administrators will see the “Manage” button for HSOPS. Tools which are still in development are indicated with a “Coming Soon” banner Network Admins see the Manage Button Displays the Network entering data

21. Viewing for CUSP4MVP-VAP Test as Mary Schmidt Survey Administration From this page you can Upload Responses, Send Email Invitations and Track Completions

22. Enter the Total Participants by clicking on the Edit Pencil Icon Viewing for CUSP4MVP-VAP Test as Mary Schmidt

23. Note the Total Participants number has been updated: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

24. When Upload Responses is selected, HSOPS results collected outside of the site in the AHRQ format can be uploaded on the following screen: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

25. When the date fields are entered, select Upload Responses and the following screen will be displayed:

26. Viewing for CUSP4MVP-VAP Test as Mary Schmidt You can also visit the Upload Responses page by selecting the View Upload Queue hyperlink. The link is visible once the Total Participants value has been entered.

27. Viewing for CUSP4MVP-VAP Test as Mary Schmidt Participants can be invited by uploading a spreadsheet of email addresses, or typing the email addresses in the field. Unique survey links are emailed to each invitee. Please note, when uploading a spreadsheet of email addresses, be careful of formatting issues such as “spaces” or special characters.

28. 28 Unique Survey Links are sent to each attendee Unique survey links are emailed to each invitee. Please be sure to inform the team that they will be receiving an email from noreply@cecitybroadcast.com, and the Subject will be “You are invited to complete HSOPS!”.noreply@cecitybroadcast.com

29. To see an example spreadsheet select the first HERE hyperlink

30. As Participants are notified, the value updates in the table: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

31. If participants DO NOT have email addresses, select the second HERE hyperlink. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

32. See Participant view of the survey below:

33. As Participants complete the survey, Administrators can track the status, as updates display on the interface: Viewing for CUSP4MVP-VAP Test as Mary Schmidt

34. If you decide to add more participants later, click on Upload Responses or Send Emails, and add the participants. After additional participants have been invited, or additional upload responses have been added, please note the status is updated, please see Total Notified:

35. Remember to update the Total Participants, to match the Total Notified. Note the Response Rate calculates accordingly. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

36. To Remove Notified Participants, click on the icon Pencil Icon next to edit the Total Notified. On the Remove Notified Participants pop-up box, select the Participant you wish to remove by selecting the box next to the email address. This will update the number in the Total Notified column. Make sure you update the Total Participants to match the Total Notified column. Only participants who have not yet completed the survey can be removed.

37. When the survey time period ends, the survey will be closed out. Remember to monitor the page for response rates, and send follow up reminders to your team, to reach a minimum of a 60% response rate. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

38. When the Survey is closed, Reports will be available for download the next day. Viewing for CUSP4MVP-VAP Test as Mary Schmidt

39. Data Available in Variety of Aggregate Reports in PDF Format HSOPS App Reports

40. Data Available in Variety of Aggregate Reports in PDF Format HSOPS App Reports

41. Questions? Reminder… You can access all slides, call recordings, and project tools at the following website: 41 https://armstrongresearch.hopkinsmedicine.org