Building Your SUSP Team Part I

1. Building Your SUSP Team Part I Armstrong Institute for Patient Safety and Quality

2. Learning Objectives • Describe the importance of your SUSP team • Develop a strategy to build a successful team • Define roles and responsibilities of team members • Identify characteristics of successful teams and barriers to team performance

3. An overview of the SUSP team

4. The Armstrong Institute Model to Improve Care Reducing Surgical Site Infections Translating Evidence Into Practice (TRiP) Surgical Unit based Safety Program (SUSP) • Emerging Evidence • Local Opportunities to Improve • Collaborative learning • Summarize the evidence • Identify local barriers to implementation • Measure performance • Ensure all patients get the evidence • Engage • Educate • Execute • Evaluate Educate staff on science of safety Identify defects Recruit executive to adopt unit Learn from one defect per quarter Implement teamwork tools Technical Work Adaptive Work http://www.hopkinsmedicine.org/armstrong_institute

5. The Peri-operative SUSP Team • Understands that patient safety culture is local • Composed of engaged frontline providers from pre-, intra-, and post-operative care areas who take ownership of patient safety • Includes staff members who have different levels of experience and perspectives • Meets regularly (weekly or at least monthly) • Has adequate resources including protected time • 2 to 4 hours per week for a team leader, surgeon, anesthesia, nurse, and infection preventionist

6. Team Performance • Inputs • Environment • Hospital & Unit Context • Team Composition • Task Design • Outputs • Performance • Attitudes • Behaviors • Processes • Inside Team • Outside Team • Team Traits

7. SUSP Team Members • Surgeons • Anesthesiologists • CRNAs • Circulating nurses • Scrub nurses / OR techs • Perioperative nurses • Executive partner • Nurse leaders • Physician assistants • Nurse educators • Anesthesia assistants • Infection preventionists • OR directors • Patient safety officers • Chief quality officers • Ancillary staff

8. Team Composition • A team leader • Champions (nurse and physician) • Local “opinion leaders” • People with diverse opinions

9. Team Composition • Someone outgoing • Someone who sees the big picture • Someone detail-oriented • Everyone dedicated

10. Successful teams have… • Reliable Processes • Education and engagement activities • Communication • Leadership support/buy-in • Conflict (and conflict resolution)

11. Successful teams have…(cont.) • Norms • Valuing individual contributions • Cohesion (team unity) • Goal agreement • Self-assessment of knowledge /skills • Participation of team members • Role clarity

12. Forming your SUSP team

13. Engage Core SUSP Team Members • Surgeons • Anesthesiologists • CRNAs • Circulating nurses • Scrub nurses / OR techs • Perioperative nurses • Executive partner • Nurse leaders

14. StephMullens CST Lead Tech Executive Kevin Driscoll CRNA CRNA Lead Renee Demski MBA Senior Director Quality Johns Hopkins Medicine Mary Grace Hensel RN Manager OR Elizabeth Wick MD Surgery Lead Sean Berenholtz MD Anesthesia Lead Deb Hobson RN “Coach” Tracie Cometa RN Lead RN Coach NSQIP Outcomes Lucy Mitchell RN NSQIP SCR

15. Tips for Engaging Physicians on the SUSP Team • Identify physician leaders • Create a forum for this role • Listen to physician concerns • Develop plans to address concerns • Reward physician leaders • Create a vehicle for communication • Develop a plan for communications

16. Physician Engagement Strategies • Create a Compact (an Agreement) with management • Clearly define what is expected of physicians • Review performance regularly

17. Example Physician Champion Compact • Hospital will provide support for percent of physicians’ time • In return, physician will do the following: • Monitor and improve quality • Implement CUSP and SSI interventions • Hold regular meetings with team • Involve other members of Medical staff in quality • Report SSI rates and learning from defects results to senior leaders and board

18. Example Physician Champion Compact • Further, physician will do the following: • Work with hospital to clarify what will be measured, who will measure it, and who will produce reports • Meet quarterly to discuss progress

19. Tips for Scheduling Your Meetings • Incorporate SUSP meetings into ongoing educational activities to ease scheduling challenges • Regularly scheduled nurse training • Grand rounds for physicians • Invite RNs to joint grand rounds • Create incentives for participating • Educational credit for participation

20. Establishing clear roles and responsibilities on your SUSP team • Armstrong Institute, 2012

21. Action Items • Form your team with an appreciation of the importance of WHO is on the team • Complete the SUSP Team Membership Form • Plan to attend Part II of Building your SUSP Team