CUSP4 is a culture change model that has been successfully applied to improve the way physicians, nurses, and other clinical team members work together. CUSP is associated with improvements in patient safety, clinical outcomes, and safety culture. The CUSP model draws on the wisdom of frontline providers who have practical knowledge about safety risks to their patients. It emphasizes the importance of a diverse team, focuses on the input of direct care providers, discusses the importance of a common goal, identifies issues that the team can successfully solve, and integrates these elements as part of the team's routine work. CUSP helps ASCs move from a culture in which a punitive response to error prevails to a culture of safety—a learning environment in which errors are treated as an opportunity to learn about root causes and prevent future errors and risks of harm.
The CUSP Toolkit
The CUSP Toolkit is available on the AHRQ Web site and includes training tools to make care safer by improving the foundation of how physicians, nurses, and other clinical team members work together. It builds the capacity to address safety issues by combining clinical best practices and the science of safety. Created for clinicians by clinicians, the CUSP Toolkit is modular and modifiable to meet your individual surgery center needs.
Ambulatory Surgery Center Implementation Training and Tools
The Ambulatory Surgery Center Implementation Training and Tools section highlights specific CUSP themes and their applicability to ambulatory surgical settings. In this section, the slide sets, videos, and tools highlight the following themes: (1) Communication and Teamwork in the Surgical Environment, (2) Coaching Clinical Teams, and (3) Patient and Family Engagement in the Surgical Environment. These modules are meant to augment the CUSP Toolkit while offering additional strategies specific to the ambulatory surgical environment.
Each module includes presentation slides, facilitator notes, and a Material Use Guide to give ASCs examples of how they can use the information in educating their team based on their facility needs. The goal of the ASC Implementation Training and Tools section is to assist ASCs with training their teams on the following topic areas:
Communication and Teamwork in the Surgical Environment
This module helps an organization improve teamwork and communication specifically in the ambulatory surgery setting. It provides an overview of the challenges with communication and teamwork in this setting and discusses methods to improve teamwork and communication.
This module has several objectives:
- Describe challenges with teamwork and communication in the surgical environment.
- Use structured briefings to improve communication and teamwork.
- Use debriefings and ongoing quality improvement.
- Demonstrate how the checklist can improve teamwork and communication.
- Learn how to use structured language to voice concerns.
- Design a quality improvement initiative using closed-loop communication.
Coaching Clinical Teams
This module discusses how to coach clinical teams to improve their performance. This is not about coaching technical skills in a clinical setting but instead coaching how to better function as a team.
This module has several objectives:
- Understand how clinical teams are currently trained in the health care setting and how coaching can help.
- Describe coaching in the clinical environment.
- Outline benefits of coaching in the health care setting.
- Identify the characteristics of a good coach.
- Demonstrate the steps a coach should follow when giving feedback to a team.
- Describe how an observation tool can improve a coach's performance.
Patient and Family Engagement in the Surgical Environment
This module focuses on patient and family engagement within the ambulatory surgery center environment. It begins by giving background information for patient and family engagement and then offers reasons for why an ASC should support engagement within its facilities. It provides patient and family expectations for care, as well as barriers, facilitators, and motivators to engagement from the patient, family, and provider perspective.
This module has several objectives:
- Define patient and family engagement, including core principles, barriers, and facilitators.
- Explain the importance of engaging patients and family members in the care of the surgical patient in an ASC.
- Determine the level of patient and family engagement at your own facility.
- Distinguish between different methods of engaging patients and family members in the health care and safety of the surgical patient.
- Apply the methods learned to scenarios in the ASC setting.
4Comprehensive Unit-based Safety Program (CUSP). August 2015. Agency for Healthcare Research and Quality, Rockville, MD.
