Engaging Senior Executives in SUSP Work
Mike Rosen, PhD and Liza Wick, MD
December 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-AssessmentInstruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF. March 2012; 42.
Colorectal SSI Rate by Quarter
(NSQIP)
Baseline
SSI Rate: 27%
Year 1
SSI: 17%
Year 2
SSI Rate: 20%
Year 3
SSI Rate: 11%??
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What do you think? (Poll)
• Do SCIP compliance and SSI reduction
require different leadership approaches at the
organizational level?
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Hear how real-world executives do SUSP work
THREE EXECUTIVE ENGAGEMENT
STORIES
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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
• SUSP work is less prescriptive
• It entails more than EMR fixes
– More problem solving and critical thinking
– “You don’t know what’s coming”
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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 Rounds
A 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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