Engaging Senior Executives in SUSP Work

Mike Rosen, PhD and Liza Wick, MDDecember 9 and December 11, 2013

Get Your Bearings

• The CUSP Toolkit: CUSP Manual Step 3 https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx

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Learning Objectives

• Distinguish between SCIP work and SUSP work from the executive perspective

• Identify common barriers to executive engagement in improvement work

• Identify successful strategies for engaging your executive in SUSP work

Surgical Care Improvement Project (SCIP)

CMS National Impact Assessment of Medicare Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF. March 2012; 42.

Colorectal SSI Rate by Quarter(NSQIP)

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Baseline Year 1 Year 2 Year 3SSI Rate: 27% SSI: 17% SSI Rate: 20% SSI Rate: 11%??

What do you think? (Poll)

• Do SCIP compliance and SSI reduction require different leadership approaches at the organizational level?

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Three Executive engagement storiesHear how real-world executives do SUSP work

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Revision of Laparoscopic GI Surgery Trays

• Problem: Lap tray had 137 instruments, and many open instruments set up for cases were never used

• Barriers: JHH Unionized Employees process open instruments. Contractor processes lap instruments.

• Intervention: Reduced lap tray to 54 instruments

• Impact: Fewer instruments to count and turnover saves money and time.

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Hidden Cost-Savings: Antibiotic Irrigation

• Problem: Frontline providers questioned the inconsistency in use of antibiotic irrigation between surgeons

• Barriers: Prominent surgeons believed in the utility of antibiotic irrigation

• Intervention: A literature review– No evidence to support use– Removed from hospital formulary

• Impact: $537,000/year savings on antibiotic irrigation

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Updating Preference Cards

• Problem: Equipment, supplies and/or instruments not available for cases

• Barriers: EPIC Rollout in JHHS, EPIC Optime • Intervention:

– Decreased number of DPCs– Removed argon from colorectal DPCs – 4 colorectal cards (open/lap, anorectal, ileostomy

reversal)

• Impact: Fewer errors, increased efficiency

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Executives’ SUSP work is unique, possibly even uncomfortable

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• SUSP work is less prescriptive• It entails more than EMR fixes

– More problem solving and critical thinking

– “You don’t know what’s coming”

The SUSP Executive partners with other senior leaders

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Important Considerations for the Executive Partnership

• Surgeons have a lot of leverage in the organization.

– Executive does not want to lose surgeon volume, especially if there are multiple competing hospitals in your area.

• Executive has many competing priorities.

– You will need to be proactive about scheduling regular meetings with your executive.

– Your team may need to make the case for meaningful executive participation in SUSP.

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SUSP Partnership can be Mutually Beneficial

• Through SUSP, the executive has an opportunity to develop strategies for the whole organization.

• The executive can share successes broadly.

• There may be financial payoff by doing improvement work with engaged clinicians (instead of to them).

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The senior executive can help lead the team to ensure:

• Is everyone clear on the goals, timelines, and mission?

• Is the necessary structure in place – people, roles, authority and responsibility?

• Are decision making, problem solving and conflict management processes clear?

• Are material resources in place – space, equipment, people, budgets?

• Are financial tracking mechanisms in place (CMS P4P implications)?

How to Engage Your Executive

• Clarify Asks– Tell the senior executive what you need (with

data!)

• Use Executive Safety Rounds to solidify the team (bring data!)

• Increase the visibility of your senior executive

• Ensure an executive is assigned to each SUSP team and participates regularly in meetings

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Pre-work Helps Make Executive Safety Rounds Successful

• Schedule monthly executive safety rounds for the year– Add a time buffer

• Prepare the senior executive– Offer a tour of your perioperative units.

– Discuss perioperative unit-specific information before the first executive safety rounds.

• Use the Executive Safety Rounds Kickoff Template to structure the meeting

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Executive Safety Rounds Kickoff Template:Make the most of your first safety rounds

https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx

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Executive Safety Rounds Kickoff Template:Make the most of your first safety rounds

• Helps your team focus the meeting with your executive partner

• Prompts your team to prepare relevant info:– Safety culture survey results

– The prioritized list of safety issues compiled from the Perioperative Staff Safety Assessment

– Pertinent information about the unit that the senior executive may not know

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Step 1. Safety Culture Survey Composite Scores

• Share your Safety Culture Survey (HSOPS) scores with your senior executive. – You can copy the composite scores graphs

from your HSOPS report.

– Consider a safety culture ‘brief’, highlighting important points or culture score results that you’d like to bring to your senior executive’s attention.

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Step 2. Collated Perioperative Staff Safety Assessment (PSSA) Responses

• Your team is administering the PSSA to your entire staff, and grouping responses by commonly identified defects.

• You can put that information in a table to help your senior executive get familiar with your clinical area’s safety priorities. – Consider building on staff’s suggestions for

improvement with specific recommendations for your senior executive.

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Step 3. Pertinent Clinical Area Information

• You can include a few bullet points or graphs with information about your clinical area that your executive may not know.

• Information may include staff turnover rate, number and type of surgical cases, safety event rates, surgical site infection rate, or other NSQIP data.

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Executive Safety RoundsA Concrete Engagement Strategy

• Begin with a senior executive walk-through of the clinical area, led by a frontline clinician.

• Solicit collaboration with sit-down discussions that are open to all staff.

Review identified safety issues together. The senior executive can help prioritize your

perioperative units’ safety concerns.

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We’d like you to try a small test of change

• Pilot Executive Safety Rounds in your hospital

• Use the Executive Safety Rounds Kickoff Template

• Share your successes and challenges on your next state coaching call. We’ll be asking:

– Have you scheduled your Executive Safety Rounds meeting?

– What strategies have you used to engage your executive?

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What questions do you have?

• Remember you have a support network– You can ask questions state coaching calls

– You can contact the SUSP helpdesk

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Project Call Evaluation

https://www.surveymonkey.com/s/SUSP_Cohort4

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