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Learn About CUSP

CUSP Toolkit

The Learn about CUSP module of the CUSP Toolkit offers an outline and brief history of the CUSP model, summarizes the CUSP Toolkit modules, and how to use them.

Contents

Slide 1. Cover Slide
Slide 2. Learning Objectives
Slide 3. CUSP Supports Kotter's Eight Steps of Change
Slide 4. CUSP Supports Kotter's Eight Steps of Change 
Slide 5. CUSP Aligns With and Supports Other Quality and Safety Tools
Slide 6. CUSP is Compatible with TeamSTEPPS
Slide 7. CUSP is Compatible with TeamSTEPPS
Slide 8. Is Your Hospital Safe?
Slide 9. Video
Slide 10. The CUSP Model
Slide 11. A Collaborative Effort
Slide 12. Toolkit Modules
Slide 13. Toolkit Users
Slide 14. Toolkit Users
Slide 15. Implementation
Slide 16. Challenges
Slide 17. Assemble the Team
Slide 18. Barriers to Team Performance
Slide 19. Engage the Senior Executive
Slide 20. The Challenges of Partnering with a Senior Executive
Slide 21. Understand the Science of Safety
Slide 22. System-Level Factors Impact Safety
Slide 23. Identify Defects Through Sensemaking
Slide 24. Examples of Defects or Errors That Affect Patient Safety
Slide 25. Implement Teamwork and Communication
Slide 26. Elements That Affect Communication and Information Exchange
Slide 27. Apply CUSP
Slide 28. The CUSP Model Generates Measurable Results
Slide 29. CUSP Results
Slide 30. Summary
Slide 31. References
Slide 32. References

Note: Slide content is presented below each of the images.

 

Slide 1. Cover Slide

Image: CUSP Toolkit logo.

Image: CUSP Toolkit logo.

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Slide 2. Learning Objectives

1. Show how CUSP supports other quality and safety tools. 2. Describe Comprehensive Unit-based Safety Program (CUSP) framework and the goals of the CUSP Toolkit. 3. Demonstrate how to apply the CUSP Toolkit in a clinical environment. 4. Review the impact of errors and patient harm and the underlying causes of errors.

  1. Show how CUSP supports other quality and safety tools.
  2. Describe Comprehensive Unit-based Safety Program (CUSP) framework and the goals of the CUSP Toolkit.
  3. Demonstrate how to apply the CUSP Toolkit in a clinical environment.
  4. Review the impact of errors and patient harm and the underlying causes of errors.

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Slide 3. CUSP Supports Kotter's Eight Steps of Change2

The modules of the CUSP Toolkit all support steps in the Kotter change model. Kotter's concept of 'Create a sense of urgency' links to the CUSP module 'Understand the Science of Safety.' Kotter's concept of 'Create a guiding coalition' links to the CUSP modules 'Assemble the Team' and 'Engage the Senior Executive.' Kotter's concept of 'Develop a shared vision' links to the CUSP module 'Identify Defects Through Sensemaking.' Kotter's concept of 'Communicate the vision' links to the CUSP modules '

 

otter CUSP Toolkit Modules
Step 1: Create a sense of urgency Understand the Science of Safety
Step 2: Create a guiding coalition Assemble the Team Engage the Senior Executive
Step 3: Develop a shared vision Identify Defects Through Sensemaking
Step 4: Communicate the vision Understand the Science of Safety
Identify Defects Through Sensemaking

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Slide 4. CUSP Supports Kotter's Eight Steps of Change2

Kotter's concept of 'Empower others to act' links to the CUSP modules 'Assemble the Team,' 'Identify Defects Through Sensemaking,' and 'Implement Teamwork and Communication.' Kotter's concept of 'Generate short term wins' links to the CUSP module 'Implement Teamwork and Communication.' Kotter's concept of 'Consolidate gains and produce more change' links to the CUSP module 'Identify Defects Through Sensemaking.'
 

Kotter CUSP Toolkit Modules
Step 5: Empower others to act Assemble the Team
Identify Defects Through Sensemaking
Implement Teamwork and Communication
Step 6: Generate short term wins Implement Teamwork and Communication
Step 7: Consolidate gains and produce more change Identify Defects Through Sensemaking
Step 8: Anchor new approaches in culture Understand the Science of Safety
Implement Teamwork and Communication

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Slide 5. CUSP Aligns With and Supports Other Quality and Safety Tools1

TeamSTEPPS. Six Sigma. Institute for Healthcare Improvement Model for Improvement. Plan-Do-Study-Act. Root Cause Analysis. Failure Mode Effect Analysis. Image: TeamSTEPPS logo and penguin.

  • TeamSTEPPS®.
  • Six Sigma.
  • Institute for Healthcare Improvement Model for Improvement.
  • Plan-Do-Study-Act.
  • Root Cause Analysis.
  • Failure Mode Effect Analysis.

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Slide 6. CUSP is Compatible with TeamSTEPPS3


 

TeamSTEPPS Step CUSP Toolkit Modules
Step 1. Create a change team. Assemble the Team
Engage the Senior Executive
Step 2. Define the problem. Identify Defects Through Sensemaking
Understand the Science of Safety
Step 3. Define the aims. Identify Defects Through Sensemaking
Step 4. Design an intervention. Identify Defects Through Sensemaking
Understand the Science of Safety

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Slide 7. CUSP is Compatible with TeamSTEPPS3

TeamSTEPPS 5. 'Develop a plan for testing the effectiveness' links to the CUSP module 'Identify Defects Through Sensemaking.' TeamSTEPPS 6. 'Develop an implementation plan' links to CUSP modules 'Engage the Senior Executive,' 'Identify Defects Through Sensemaking,' and 'Understand the Science of Safety.' TeamSTEPPS 7. 'Develop a plan for sustained improvement' links to the CUSP module 'Understand the Science of Safety.' TeamSTEPPS 8. 'Develop a communication plan' links to CUSP modules 'Assemble

 

TeamSTEPPS Step CUSP Toolkit Modules
Step 5. Develop a plan for testing the effectiveness. Identify Defects Through Sensemaking
Step 6. Develop an implementation plan. Engage the Senior Executive
Identify Defects Through Sensemaking
Understand the Science of Safety
Step 7. Develop a plan for sustained improvement. Understand the Science of Safety
Step 8. Develop a communication plan. Assemble the Team
Engage the Senior Executive
Identify Defects Through Sensemaking

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Slide 8. Is Your Hospital Safe?

Would you want a loved one to be a patient at your hospital? Your unit? Would you want to be a patient in the unit where you work? Can you say with 100 percent certainty that you believe that your hospital does everything it can to protect its patients? Image: A patient in a hospital bed surrounded by a family member and two clinicians.

  • Would you want a loved one to be a patient at your hospital? Your unit?
  • Would you want to be a patient in the unit where you work?
  • Can you say with 100 percent certainty that you believe that your hospital does everything it can to protect its patients?

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Slide 9. Video

Slide 9. Video

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Slide 10. The CUSP Model

Created through a collaborative effort of the Agency for Healthcare Research and Quality and state and national-level innovators in patient safety. Dovetails with, and supports, a range of quality and safety improvement models. Encompasses a wide range of safety tools and approaches. Based on the understanding that all culture is local, and that work to improve culture must be owned at the unit level. Believes that harm is not an acceptable 'cost of doing business'. Can be applied by anyone, any

  • Created through a collaborative effort of the Agency for Healthcare Research and Quality and state and national-level innovators in patient safety.
  • Dovetails with, and supports, a range of quality and safety improvement models.
  • Encompasses a wide range of safety tools and approaches.
  • Based on the understanding that all culture is local, and that work to improve culture must be owned at the unit level.
  • Believes that harm is not an acceptable 'cost of doing business'.
  • Can be applied by anyone, anywhere.

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Slide 11. A Collaborative Effort4

Teams at the Johns Hopkins Quality and Safety Research Group originally developed the CUSP model with funding from the Agency for Healthcare Research and Quality. An infection reduction project of the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality proved that CUSP was successful. The Health Research and Educational Trust of the American Hospital Association led 'On the CUSP: Stop BSI' and other national projects to apply the CUSP model. The CUSP Toolkit u

  • Teams at the Johns Hopkins Quality and Safety Research Group originally developed the CUSP model with funding from the Agency for Healthcare Research and Quality.
  • An infection reduction project of the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality proved that CUSP was successful.
  • The Health Research & Educational Trust of the American Hospital Association led On the CUSP: Stop BSI and other national projects to apply the CUSP model.
  • The CUSP Toolkit using Kotter's change model combines the CUSP model, with existing frameworks like TeamSTEPPS, Just Culture, and others to provide complete tools to support units in improving culture.

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Slide 12. Toolkit Modules

Learn About CUSP. Assemble the Team. Engage the Senior Executive. Understand the Science of Safety. Identify Defects through Sensemaking. Implement Teamwork and Communication. Apply CUSP.

  • Learn About CUSP.
  • Assemble the Team.
  • Engage the Senior Executive.
  • Understand the Science of Safety.
  • Identify Defects through Sensemaking.
  • Implement Teamwork and Communication.
  • Apply CUSP.

Note: After a unit's first implementation of CUSP, modules can be used in any order, depending on the needs of the unit or organization.

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Slide 13. Toolkit Users

Senior executives, Patient safety officers, and Nurse managers.

  • Senior executives:
    • Help leaders prioritize improvement efforts.
    • Provide resources for interventions to alleviate defects.
  • Patient safety officers:
    • Work with senior executives and managers to maintain an ongoing infrastructure for improvement activities.
  • Nurse managers:
    • Educate staff on the science of safety.
    • Provide opportunities for staff to learn and practice using teamwork and communication tools.
    • Work with senior executives and managers to maintain an ongoing infrastructure for improvement activities.

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Slide 14. Toolkit Users

Frontline staff: Engage with Stakeholders in safety improvement. Physician champions: Share knowledge on the immediate and long-term benefits of teamwork and communication tools.

  • Frontline staff:
    • Engage with Stakeholders in safety improvement.
  • Physician champions:
    • Share knowledge on the immediate and long-term benefits of teamwork and communication tools.

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Slide 15. Implementation

Share videos with teams to spark engagement in staff safety assessments. Provide templates and discussion guides to project leads. Educate teams on the science of safety. Use videos and training modules to orient new clinical staff. Train teams in using teamwork and communication tools. Engage senior executives and physician champions.

  • Share videos with teams to spark engagement in staff safety assessments.
  • Provide templates and discussion guides to project leads.
  • Educate teams on the science of safety.
  • Use videos and training modules to orient new clinical staff.
  • Train teams in using teamwork and communication tools.
  • Engage senior executives and physician champions.

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Slide 16. Challenges

Applicability and usability of CUSP within specialty units (i.e. NICU, oncology). Senior executive engagement and participation. High staff turnover. Nurse empowerment.

  • Applicability and usability of CUSP within specialty units (i.e. NICU, oncology).
  • Senior executive engagement and participation.
  • High staff turnover.
  • Nurse empowerment.

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Slide 17. Assemble the Team

Text Description is below the image. Image: Team members standing together.

  • Understand the importance of your CUSP team.
  • Develop a strategy to build a successful team.
  • Identify characteristics of effective teams and barriers to team performance.
  • Define roles and responsibilities of team members.

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Slide 18. Barriers to Team Performance3

Inconsistency in team membership. Lack of time. Lack of information sharing. Hierarchy. Varying communication styles. Presence of conflict. Lack of coordination and follow-up. Misinterpretation of cues. Lack of role clarity. Image: Team member standing before a brick wall.

  • Inconsistency in team membership.
  • Lack of time.
  • Lack of information sharing.
  • Hierarchy.
  • Varying communication styles.
  • Presence of conflict.
  • Lack of coordination and follow-up.
  • Misinterpretation of cues.
  • Lack of role clarity.

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Slide 19. Engage the Senior Executive

Text Description is below the image. Image: Two senior executives standing next to each other.

  • Identify characteristics to search for when recruiting the senior executive.
  • Describe the responsibilities of the senior executive.
  • Explain the role of the senior executive in addressing technical and adaptive work.
  • Explain how to engage the senior executive and develop shared accountability for the work.

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Slide 20. The Challenges of Partnering with a Senior Executive

May lack clinical background. May not recognize the value of CUSP. May not be able to meet with the CUSP team regularly.

  • May lack clinical background.
  • May not recognize the value of CUSP.
  • May not be able to meet with the CUSP team regularly.

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Slide 21. Understand the Science of Safety

Text Description is below the image. Image: Team members standing next to a line cart.

  • Describe the historical and contemporary context of the Science of Safety.
  • Explain how system design affects system results.
  • List the principles of safe design and identify how they apply to technical work and teamwork.
  • Indicate how teams make wise decisions when there is diverse and independent input.

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Slide 22. System-Level Factors Impact Safety5

Image: Concentric circles show the layered factors of patient safety. Institutional factors, hospital factors, departmental factors, work environment factors, team factors, individual provider factors, task factors, and patient characteristics all have an effect on patient safety.

  • Institutional.
  • Hospital.
  • Departmental Factors.
  • Work Environment.
  • Team Factors.
  • Individual Provider.
  • Task Factors.
  • Patient Characteristics.

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Slide 23. Identify Defects Through Sensemaking

Text Description is below the image. Image: Team members standing around a wall chart.

  • Introduce CUSP and Sensemaking tools to identify defects and errors.
  • Discuss the relationship between CUSP and Sensemaking.
  • Show how to apply CUSP and Sensemaking tools.
  • Discuss how to share findings.

Note: This module combines the CUSP steps Identify Defects and Learn from Defects.

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Slide 24. Examples of Defects or Errors That Affect Patient Safety

The table presents a series of defects and their interventions: 1. Unstable oxygen tanks on beds resulted in an intervention in which oxygen tank holders were repaired or new holders were installed across the institution. 2. A medication look-alike incident led to an intervention in which education was conducted, medications were physically separated, and letters were sent to the manufacturer. 3. Missing equipment on a cart resulted in the development of a checklist for stocking the cart.
 

Defect Intervention
Unstable oxygen tanks on beds Oxygen tank holders repaired or new holders installed institution wide
Medication look-alike Education conducted, medications physically separated, and letter sent to manufacturer
Missing equipment on cart Checklist developed for stocking cart
Inconsistent use of Daily Goals rounding tool Consensus reached on required elements of Daily Goals rounding tool
Inaccurate information by residents during rounds Electronic progress note developed

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Slide 25. Implement Teamwork and Communication

Text Description is below the image. Image: TeamSTEPPS logo and penguin.

  • Recognize the importance of effective communication.
  • Identify barriers to communication.
  • Describe the connection between communication and medical error.
  • Identify and apply effective communication strategies from CUSP and TeamSTEPPS.

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Slide 26. Elements That Affect Communication and Information Exchange

Interruptions. Task absorption. Verbal abuse. Fatigue. Not following plan of care. Ambiguous orders or directions. Change in team members. Work load.

  • Interruptions.
  • Task absorption.
  • Verbal abuse.
  • Fatigue.
  • Not following plan of care.
  • Ambiguous orders or directions.
  • Change in team members.
  • Work load.

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Slide 27. Apply CUSP

Introduce Just Culture principles. Learn how Just Culture principles can augment CUSP. Review key steps of the CUSP Toolkit. A Just Culture system: Holds itself accountable. Holds staff members accountable. Has staff members that hold themselves accountable. Image: Team members standing together.

  • Introduce Just Culture principles.
  • Learn how Just Culture principles can augment CUSP.
  • Review key steps of the CUSP Toolkit.

A Just Culture system6

  • Holds itself accountable.
  • Holds staff members accountable.
  • Has staff members that hold themselves accountable.

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Slide 28. The CUSP Model Generates Measurable Results7

CUSP in Michigan ICUs: Correlated with significant improvements in safety climate in 71 units. Overall mean safety climate scores significantly improved from 42.5 percent (2004) to 52.2 percent (2006). In 2009, more than 350 hospitals in 22 States reduced CLABSI rates by an average of 35 percent after implementing CUSP.

  • CUSP in Michigan ICUs:
    • Correlated with significant improvements in safety climate in 71 units.
    • Overall mean safety climate scores significantly improved from 42.5 percent (2004) to 52.2 percent (2006).
  • In 2009, more than 350 hospitals in 22 States reduced CLABSI rates by an average of 35 percent after implementing CUSP.

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Slide 29. CUSP Results

Heightened engagement of staff and senior leaders. Improved communication among care team members. Shared mental models. Expanded knowledge of potential hazards and barriers to safety. Collaborative focus on systems of care. Image: An arrow sweeping upward to depict CUSP results that build on each other.

  • Heightened engagement of staff and senior leaders.
  • Improved communication among care team members.
  • Shared mental models.
  • Expanded knowledge of potential hazards and barriers to safety.
  • Collaborative focus on systems of care.

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Slide 30. Summary

CUSP integrates with and supports a broad range of quality and safety models. Communication is cited as a root cause of most errors. Individuals across an organization can use the CUSP Toolkit and expect measurable results.

  • CUSP integrates with and supports a broad range of quality and safety models.
  • Communication is cited as a root cause of most errors.
  • Individuals across an organization can use the CUSP Toolkit and expect measurable results.

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Slide 31. References

References

  1. Agency for Healthcare Research and Quality, Department of Defense. TeamSTEPPS. Available at http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.
  2. Kotter J, Rathgeber H. Our iceberg is melting: Changing and succeeding under any conditions: 1st ed. New York, St. Martin's Press; 2006.
  3. Agency for Healthcare Research and Quality, Department of Defense. TeamSTEPPS. Available at http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.
  4. Health Research and Educational Trust, Johns Hopkins University Quality and Safety Research Group, Michigan Health & Hospital Association Keystone Center for Patient Safety and Quality. Eliminating CLABSI: A national patient safety imperative a progress report on the National On the CUSP: Stop BSI project. Rockville, MD; Agency for Healthcare Research and Quality, April 2011. AHRQ Publication No: 11-0037-EF.

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Slide 32. References

References

  1. Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. BMJ 1998;316:1154-7.
  2. Griffith, S. Just Culture. Plano, TX: Outcome Engineering; 2011.
  3. Pronovost P, Goeschel C, Colantuoni E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.

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Page last reviewed December 2012
Page originally created December 2012

Internet Citation: Learn About CUSP. Content last reviewed December 2012. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/hai/cusp/modules/learn/sl-cusp.html

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