Hawaii Surgical Unit Safety Program: The Journey Begins with the Comprehensive Unit-Based Safety

Program

May 21, 2013Della M. Lin, M.D.

dlinmdconsult@yahoo.com

Hawaii Safer Care SUSP

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“the most common cause of failure in leadership is produced by treating adaptive challenges as if they

were technical problems.”

Ron Heifetz

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

It Takes Three!

Robust DataImplementation of Evidence-Based Measures

Effective Safety Culture

Hawaii CUSP-CLABSI collaborative

Hospital Acquired Infections (CLABSI) SIR scores: CMS Hospital Compare

• PR 1.58• MS 0.91• MD 0.87• ME 0.84• LA 0.81• 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• DC 0.63

• KS 0.33• MI 0.32• SD 0.24• HI 0.17

• IL 0.50• WY 0.49• VT 0.48• OR 0.47• PA 0.46• MO 0.46• ID 0.45• OH 0.44• AR 0.44• WA 0.42• IN 0.41• MN 0.38• DE 0.37• ND 0.37• AK 0.35

• VA 0.62• NE 0.59• OK 0.58• GA 0.58• WI 0.55• CA 0.54• WI 0.54• UT 0.54• CO 0.53• TX 0.52• NM 0.52• NC 0.51• IA 0.51• Fl 0.51• MA 0.50

Accessed 8/20/2012 http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare.html

“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.”

SUSP

Technical – Practices to Prevent Harm

Evidence Based Practice

1. Audit Tools Education on the Evidence

1. Presentation of evidence

2. Fact Sheet3. Cost Estimator4. Summary of

Professional Organization Recommendations

5. Annotated bibliography

Implementation/

Sustaining

1.Checklist 2.Policy /

Procedures 3. Protocol s4. Monitoring6. 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. Education2. Briefings

Learning from Defects

1. LFD toolkit2.RCA of each

incidence

Implement Tools for Teamwork and

Communication

1. Surgical Safety Briefing 2. Huddles 3. Debriefing 4. Shadowing 5. Handoff Tool6. TeamSTEPPS

Tools

Assemble a SUSP team, Partner with a Senior Executive;

Baseline Data

Quality Improvement

Tools 1. PDCA2. Lean/Six

Sigma3. Reliable System

Process4. TCAB 5. Other

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

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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

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