Eugene S. Chu, MD, FHM
Director of Hospital Medicine
Boulder Community Health
Associate Clinical Professor of Medicine
University of Colorado School of Medicine
Image: On bottom left of every slide is the CUSP symbol.
- Differentiate between implementation and sustainment.
- Identify key elements in sustainment of process improvement initiatives.
- Recognize the patient care unit’s readiness for sustainment.
- Describe the steps to sustainment.
Sarah Krein, PhD, RN
Research Associate Professor
Division of General Medicine
University of Michigan
Mohamad Fakih, MD, MPH
Infection Prevention and Control
St. John Hospital and Medical Center
Images: Photos of Drs. Krein and Fakih.
Journal Articles on Sustainment
Images: Screen shots from the title and author sections of 2 journal articles.
Image: Chart showing progress from Engaging and Education to implementation of CUSP. Two lines go up and slowly go down.
Image: Chart showing progress with Execute and Evaluate in the middle of chart to implementation of CUSP. Two lines go up and slowly go down.
Image: Chart showing progress with Sustainment at the end of chart to implementation of CUSP. Two lines go up and slowly go down.
Image: On top left side of slide is an image of a brain with three little people around it, with one of them standing on top.
Image: On top left side of slide is an image of a brain with three little people around it, with one of them standing on top, and to the right is a red heart.
Same slide as slide 10, only there is a picture of a tree in the middle of a field as background to the words Technical Socio-Adaptive.
…the shared set of social values and beliefs, both explicit and implicit, that guides actions and decisions within the organization
A coherent culture is one in which there is widespread agreement around core values and beliefs.
“I know it when I see it.”
Potter Stewart 1915-1985
Image: Portrait of Potter Stewart.
The 4 E’s of Change
Same slide as slide 17, only the words Engage and Effectiveness are circled.
Image: Elderly man in hospital bed getting an IV.
What is the diagnosis?
- C. diff
Image: Same elderly man as on slide 20.
Indication for UC?
- Patient comfort
- Nurse convenience
- No indication
Image: Elderly woman with the hand of a health professional on her shoulder.
Image: Small drawing to the right showing a woman with a book opening imagining scenes from a fairy tale.
What did the staff do with Mrs. B’s urinary catheter?
- Change it to an antimicrobial coated catheter.
- Leave it in, it’s more convenient for everyone.
- Change it out every 3 weeks.
- Wait until she fell asleep to take it out.
|Daily Census||ALOS||Yearly Admits||Foley Rate||Annual Savings|
Images: To the right of the text is the image of a stick figure holding a flag on top of a hill. On the left is the cover of the book "Leading Change" by John P. Kotter.
Same slide as slide 17, only the words Educate, Institutionalization, and Capacity are circled.
CAUTI rates, definitions
Aseptic Insertion Technique
CAUTI definition changes 2015?
- Requirement for ≥ 100,000 CFU/ml organisms in urine culture
- Exclusion of non-bacteria as sole pathogens
- Use of same pathogen list for symptomatic UTI (SUTI) and asymptomatic bacteremic UTI (ABUTI)
- All of the above
Same slide as slide 17, only the words Environment, Institutionalization, and Capacity are circled.
People ⇔ Things
Procedures ⇔ Protocols
Image: Photo of smiling health professionals.
Keep Effort Priority
Liaison with Peers
Images: Photos of a hospital commode, a hospital monitor, a catheter tube, and a male urinal.
Image: Screen shot of the flowchart titled Foley Catheter Removal Protocol.
Image: Screen shot of the form titled Device Risk Evaluation Tool.
Same slide as slide 17, only the words Evaluate and Context are circled.
Internal Environment: organization geared towards quality and safety. leaders adopting best practices, employee satisfaction and morale
(Krein et al, Soc Sci Med 2010; 71: 1692-1701)
External Environment: public reporting, value based purchasing, hospital acquired condition penalties
Use data to assess progress:
- Hospital Survey on Patient Safety
- Infection rates
- Process measures
- Organizational and team culture
National → State → Hospital → Unit → Provider
Image: Cartoon of a report card with all A+'s.
Our Metrics Are...
- chart reviewed
National → State → Hospital → Unit → Provider
Images: Cartoon of a report card with all A+'s and a wrench.
Don't Forget the Cookies
Image: Photo of a plate of cookies.
Implementation → Sustainment
Image: Line graph showing 2 bell curves and the first third of the chart is labeled Engage and Educate, the middle third is labeled Execute and Evaluate, and the last third is labeled Sustainment.
Same slide as Slide 17.
Program Sustainability Conceptual Model
(Shediac-Rizkallah, Health Educ Res 1998; 13: 87-108)
Image: Figure showing a framework for conceptualizing program sustainability. The three components that make-up Program Sustainability include: 1) Factors in the broader community environment 2) Factors within the organizational setting 3) Project design and implementaion factors. Program Sustainability is defined as: 1) Maintenance of health benefits from a program 2) Institutionalization of a program within an organization 3) Capacity building in the recipient community.
Prepared by the Health Research & Educational Trust of the American Hospital Association with contract funding provided by the Agency for Healthcare Research and Quality through the contract, “National Implementation of Comprehensive Unit-based Safety Program (CUSP) to Reduce Catheter-Associated Urinary Tract Infection (CAUTI), project number HHSA290201000025I/HHSA29032001T, Task Order #1.”