Comprehensive Unit Based Safety Program    A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement in Wisconsin’s hospitals    July 2013 Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation.

A four part Series 2 Part I – May 14 The Science of Safety and forming the CUSP team Part II – June 11 The Staff Safety Assessment & Safety Huddles Part III – July 9 Identifying Defects Part IV – August 13 Learning from Defects

Identify Defects I.Review Assignments & mid-month survey II.The process of identifying barriers III.Barrier Identification and Mitigation Tool IV.Culture Check-Up V.30 day Action Items 3

Action Item Review 4 Options to Try Conduct a Staff Safety Assessment (if you haven’t already) Working with your Executive Sponsor, assess, then prioritize, staff safety assessment findings using the Safety Issues Worksheet Try Testing: Safety Huddle and/or Daily Goals Checklist Determine how staff bring up a just in time safety concern (AHRQ Survey Results, or discussion)

Review - the Staff Safety Assessment 5 Just two (2) very important questions for any clinical unit:

6 Mid Month Review Poll Did you conduct a staff safety assessment and share the findings with your executive sponsor? Yes No

Discussion Did you determine how staff bring up a just in time safety concern in your unit? What did you learn? 7 Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad to mute)

The Barrier Mitigation Process 8

The “Both – And” of CUSP 9 Barrier Mitigation Process

Why Examine “Barriers”?  99% of clinical staff don’t come to work intending to make mistakes!  Procedures, policies, and processes are typically written down, and taught. Which leads to….Something getting in the way of doing things the right way (leading to a defect). Your team should find out what the “something” is. 10

Barrier Mitigation Process 11 Step 1 - Assemble the Team and Identify Barriers  Prioritize if necessary Step 2 – Compile & summarize the Barrier Information Step 3 – Develop an Action Plan for Each Targeted Barrier

Prioritize Your Findings Prioritize each finding from the Staff Safety Assessment: Likelihood: How likely is it that a clinician on the unit could be involved in a similar potential harm situation? 1.Low 2. Moderate 3. High 4. Very High Severity: How likely is it that a patient may be harmed if this situation isn’t improved? 1. Low 2. Moderate 3. High 4. Very High 12

Prioritize Your Findings Low Likelihood High Likelihood High Severity Low Severity Take Action on these!

Step 1: Assemble an Interdisciplinary Team 14 Determine who should be involved in assessing the barriers? Involve those who actually do the work Detailed directions in WHA Improvement Workbook – Section 5, page 5-4

Step 2: Identify Barriers 15 Seeing something very familiar, for the very first time. Observe: Observe a few clinicians engaged in the tasks related to the task, process, or guideline. Discuss: Ask various staff members about the factors influencing proper task performance or guideline adherence. Walk the Process: Consciously follow the process or guideline during a simulation, or if appropriate, during real clinical practice.

Barrier Identification Form 16 Carefully assess Provider, Guideline/Process and System Factors. Observe separately & compare notes. Each CUSP team member could interview a different clinician.

Step 3: Compile and Summarize 17

The “Both – And” of CUSP 18 Culture Check-up Process

Talking to Staff About Safety The biggest challenge: “How do we get staff to “open-up” about areas of risk they may be seeing in their day to day work?” 19 Use the CUSP Culture Check up Tool

Culture Check Up A process for using your Safety Culture Survey results (whether AHRQ or another survey) Select an item where responses indicate a need for improvement (an item were the average response is 3 or below or a domain score with less than 60% agreement). Provides a structured opportunity for leadership to hear the staff perspective. 20

AHRQ Survey Example 21 For example, your hospital scores an average of 3.14 on this survey question as compared to an average of 4.3 on other survey questions. This is an indication of an opportunity for improvement in your Culture of Safety The goal is for each AHRQ question to be answered “Strongly Agree”

Culture Check up Toolkit 22

Conducting a Culture Check-Up 23 Step 1: Convene a representative group of frontline caregivers for a minute discussion. This can be informal over lunch breaks, or a formal agenda item for unit/departmental meetings. As a rule of thumb, 5 to 7 caregivers of mostly mid-level seniority will facilitate a rich discussion. Step 2: Review the unit patient safety culture assessment results and the key item with the group. Step 3: Assign someone to complete the Culture Item Discussion Form, to document the issues that surface and suggested improvement actions.

Conducting a Culture Check-Up 24 Step 4: Remind participants to use active listening skills to guide participant feedback. This is not a meeting to rationalize or justify issues, but rather a time to focus on identifying opportunities to improve local culture. Step 5: Conclude the meeting with agreement on making at least one change that could positively affect the cultural issue discussed, and commit to revisit whether the change resulted in improvement in 6 months.

When to do a Culture Check-up? Do no more than one per quarter. Choose at the most 3 or 4 things from your AHRQ Safety Culture Survey to work on each year. Great to share the findings with your Quality Council, Management Team, or Medical Staff – to raise awareness of issues. 25

In the next 30 days 26 ACTION ITEMS Prioritize findings from the Staff Safety Assessments (if you haven’t done so already) Conduct a Barrier Assessment using the Barrier Identification and Mitigation (BIM) Toolkit for one of your findings (WHA Workbook section 5-4 and 5-5) Schedule or conduct a Culture Check-up based on your “worst” AHRQ scores (WHA Workbook section 5-2)

Quality Center Resources 27 CUSP page on the Quality Center website ( center.org)

Thank You Questions? Jill Hanson Stephanie Sobczak