Sustaining and Spreading Surgical
Safety Improvements with SUSP
Mike Rosen, PhD
Elizabeth Wick, MD
ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY
Polling Question #1
What is your current role?
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Surgeon
Quality improvement practitioner
Infection preventionist
OR nurse
OR technician
Anesthesiologist
OR manager
Other
Objectives
• Define sustainment and spread
• Determine if you are ready to sustain
• Plan key actions for sustainment
• Prioritize needs for successful sustainment
Sustainment is…
• What you do to continue to build on your
successes
• How you persist in your efforts to change
culture and improve safety
• When you apply the process of surgical safety
improvement efforts to new challenges
Adaptive or Technical?
Adaptive
CUSP
Technical
SSI’s
Why worry about sustainment?
• Recidivism is not pretty
• Failure rates
• Risks to sustaining progress
– Staff turnover
– Overlying priorities
– Organizational changes
Definition of Spread 1
• “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.”
Polling Question #2
How ready are you to sustain? On the previous
slide, how many of the boxes could you check?
• 0-1 Not so ready yet
• 2-3 We are still implementing
• 4-5 We are close
• 6+ Ready to sustain our progress
What do effective teams look like?
Effective teams have:
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Regular meetings
Active surgical 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
What sustainment strategies work?
• Stick to formal processes
– Test changes on small scale first
– Measure and make data-driven decisions
• Maintain access to continuous feedback
– Require current data to validate progress
What sustainment strategies work?
• Secure time and resources
– Formalize job responsibilities for SUSP and patient safety
improvement—protected time for doing QI work
– Dedicated financial resources and personnel
– Make data support available
• Take care of your team
– Plan for team growth and turnover
– Offer highly engaged team members professional
development opportunities
We are ready to sustain: Now what?
 Re-administer Perioperative 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 SUSP activities
 Continue collaborative activities
 Revisit the “right team mix” and augment needs as team
and projects evolve
Preview of Pre-mortem
Looking ahead to the next session• Imagine that your teams’ gains in technical and
adaptive work have slipped away. You’re back where
you began.
• Why? List all the reasons you can that would result in
loss of the gains you’ve made in SUSP.
• Review the CUSP Pre-Mortem Tool and jot down
responses
Resources
Look for these resources on the SUSP Project Site
• Perioperative Staff Safety Assessment (PSSA)
• Learning from Defects through Sensemaking (LFD) Tool
• CUSP Pre-Mortem Tool
URL: https://armstrongresearch.hopkinsmedicine.org/susp/cusp/resources.aspx
Remember, we are here to help!