On the CUSP: STOP BSI

1. On the CUSP: STOP BSI Christine A Goeschel RN MPA MPS ScD (candidate) Tennessee Center for Patient Safety December 2, 2009

2. Learning Objectives • To consider to make your investment of time and improvements in BSI rates last forever • To make sure all patients in your institution have access to the same level of central line safety • To share what you know about how to create strong teamwork and safe culture

3. Sustaining Change:“On the CUSP: Stop BSI” • Are necessary structures and human resources in place – policies, people, roles, authority and responsibility? • Are project support processes codified and clear: decision making, problem solving, coordination and conflict management? • Are material resources in place – space, equipment, supplies, • Are performance tracking mechanisms in place?

4. Action Items for Senior Leaders • Make certain an executive is assigned to each team and meets routinely with them • let the staff know senior leaders are invested and will work as hard as they do to reduce infections and improve culture • Set clear project goals and expectations for the leaders and staff Provide opportunities for project teams to meet with senior leaders and the board to discuss the project • Provide the necessary resources – time to work on the Project, funds for travel, training, equipment, supplies, etc.

5. Action Items for Senior Leaders • 3. Support transparent communication • BSI rates • Process barriers and successes • Tell your own Josie Story; publically discuss a patient who suffered preventable harm at your organization • 4. Expect resistance and be prepared to address it effectively • 5. Celebrate wins and provide encouragement, support, attention, and resources if there are set backs.

6. Implementation Framework

7. Implementation Framework

8. Endure—Plan for Sustainability • Why worry about the distant future? • What you can anticipate: • Turnover of staff • New projects/ distractions • Complacency • Emergencies and complex cases (someone will call for exceptions to be made)

9. Endure—Plan for Sustainability • Things you can do now to support long term viability of the BSI reduction • Write it into policy • Include in training for all new members • Check to be sure it is routine practice • Set up reliable supply chain (borrowing protocol; alert system) • Quarterly review by executive partner • Set up a Learning Network of peers • Have regular meetings with your HEIC dept

10. Expand—Spread the Interventions • Why think about expanding to other units? • Requires self study • Solidifies own understanding • Equal protection for all patients • Unique challenges of other units may offer new ideas and methods

11. Expand—Spread the Intervention • What quality and safety issues are a priority in your organization? • Might CUSP provide a foundation for progress? • Understand the science of safety • Staff Safety Assessment • Partner with Executives • Learn from Defects • Implement teamwork tools

12. Action Items Plan now to sustain the interventions until empirical evidence or law dictates the need for change Policies Procedures Process measures Performance measures Create an incremental plan to roll out the intervention across the hospital Units that insert central lines (short and long term use) Units that maintain central lines

13. For More Information • cgoesch1@jhmi.edu • www.safercare.net “Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has.” Margaret Meade

14. Reference List • Buchanan D, Fitzgerald L, Ketley D, Gollop R, Jones JL, Saint Lamont S, Neath A and Whitby E. No going back: A review of the literature on sustaining organizational change. International Journal of Management Reviews 2005; 7(3):189-205. • Evashwick C, Ory M. Organizational characteristics of successful innovative health care programs sustained over time. Fam Community Health. 2003 Jul-Sep;26(3):177-93. • Greenhalgh T, Robert G, Macfarlane F, Bate P and Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82(4):581-629.