1. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 CUSP for VAP Adaptive CUSP Sustainability Sustainment and Spread David A. Thompson, DNSc, MS, RN November 6, 2014

2. Objectives 2 Define sustainment and spread Determine if you are ready for both Plan key actions for sustainment Define strategies of High Reliability Organizations Prioritize needs for successful sustainment Discuss Learning Networks for sustainment

3. Adaptive or Technical 3 Adaptive CUSP Technical VAP

4. Technical Sustainability – Review How do you keep interventions in the forefront? What do you do to continue to build on your successes? How do you persist in your efforts to change culture and improve safety?

5. Adaptive Sustainment is… How do you apply the process of CUSP for VAP improvement efforts to new challenges High reliability organizations –What are they? –How do you get there? 5

6. Why Worry About Sustainment? Failure rates Risks to sustaining progress –Staff turnover –Overlying priorities –Organizational changes 6

7. Why Worry About Sustainment and Spread? “Spreading takes the process from the narrow, segmented population(s) or group(s) and broadens it to include all the population(s) or group(s) that will use the process.” “Formalizing a process provides a reference to others; those new to the organization and those in the organization needing clarity about the specifics of the process.” 7

8. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Sustaining this work is a tall order: How can I do this?

9. Hold regular meetings Have engaged participation from stakeholders Frontline staff Executive partner(s) Built, implemented, and evaluated the VAP bundle Learn from at least one defect per quarter Use data systems for ongoing entry and feedback Share data with frontline staff regularly Sustainability Self-assessment

10. Audience Poll: What aspects do you feel are most critical to sustainment at your site?  Training on the science of safety  Staff safety assessment (how will the next patient be harmed, and what can we do to prevent that?)  Learning from defects  Safety culture assessment and debrief (HSOPS)  Implementing tools to improve teamwork  Partnering with an executive leader  Sharing and learning with your peers in a collaborative setting Why? -Type in chat box

11.  Training on the science of safety  Staff safety assessment (how will the next patient be harmed, and what can we do to prevent that?)  Learning from defects  Safety culture assessment and debrief (HSOPS)  Implementing tools to improve teamwork  Partnering with an executive leader  Sharing and learning with your peers in a collaborative setting Why? -Type in chat box Audience Poll: Which of these do you feel will be the hardest to sustain?

12. Effective teams have… Regular meetings Active CUSP for VAP champions who partner with others Executive/Leadership support Believe that progress is possible Invent ways to create engagement (and then reinvent more ways) Frequent communication

13. How do I keep this going? Stick to formal processes Test changes on small scale first Measure and make data-driven decisions Maintain team connections and progress Keep your team together and meet regularly Plan for growth and change Maintain access to continuous feedback Require current data to validate progress Integrate with existing organizational processes Reporting and accountability - include governance structures Incorporate into training programs / job descriptions Adapt language to fit goals into local culture / organization

14. Apply CUSP to Any Patient Safety Topic 14 Build and rebuild organizational capacity Ensure teams are multi-disciplinary Continue building internal expertise Increase staff participation in decision-making process Secure time and resources Formalize job responsibilities for QI and patient safety improvement – this includes protected time for doing CUSP for VAP work Dedicate financial resources and personnel – data support is available for the next year on the CECity data portal Who can collect data? Align goals within broader organization and external requirements

15. Specific Techniques for Sustainability Revisit your Phaseline document, steps of CUSP Re-administer Staff Safety Assessment (2 question survey) every 12-18 months Complete Learning From Defects (LFD) tool at least once quarterly Share results and stories with frontline staff Orient all new staff to the Science of Safety Continue updating staff on CUSP for VAP activities Implement/create/use teamwork tools Revisit the “right team mix” and augment needs as team and projects evolve

16. Assess Risk for Harm 1.Please describe how you think the next patient in your clinical area will be harmed. 2.Please describe what you think can be done to prevent or minimize this harm. 16 Use the Staff Safety Assessment (PSSA)

17. Audience Poll: Assessing Your Needs What will be most helpful for sustaining your CUSP for VAP efforts?  Ongoing state-based coaching calls – how often?  Learning networks?  Face time with peers?  Ongoing listserve for peer-to-peer support?  Other ideas?

18. Sustainability Barriers and Successes Who would you like to hear more from about sustainability of your gains?  Peers at other hospitals  Hopkins, National Project Team (NPT)  Successful participants in other CUSP- related projects 18

19. We Are Here to Help and Support You 1.What support do you need to get started to sustain your improvement program? 2.How can the CUSP for VAP project team help you going forward?

20. Pre-Mortem for Sustainability Imagine that your teams’ gains in technical VAP and adaptive CUSP work have slipped away. You’re back where you began. Why? List all the reasons that would result in the loss of the gains and progress you’ve made since starting this VAE prevention work. 20

21. Resources National CUSP 4 MVP – VAP Project –https://armstrongresearch.hopkinsmedicine.org/C USP4MVP.aspxhttps://armstrongresearch.hopkinsmedicine.org/C USP4MVP.aspx –Currently recruiting for Cohort 2 –New and improved toolkits and resources available to CUSP for VAP teams –You’re welcome call-in to webinars –Previously recorded webinars can be accessed online 21

22. Next Steps Complete the Exposure Receipt Assessment Start collecting Process Measure data – choose the sampling strategy optimal for your unit Structural Assessment coming in December Next content/coaching webinar is December 4 th -VAE Surveillance -2015 Changes to the CDC VAE Definition 22

23. Thank You A sincere THANK YOU for all of your effort and hard work to reduce the incidence of VAP in your units and prevent HAIs! 23