Cultural Improvement as a Basis for Implementing and Sustaining Patient Safety Initiatives

Background/Significance: The history of quality improvement and patient safety in health care has demonstrated that the implementation of interventions without attention to behavior change has not yielded sustainable improvements. In addition, as culture has greater variation from one hospital unit to another than between hospitals, change programs are better targeted at a unit level versus a hospital-wide effort. Over the course of the past seven years, the MHA Keystone Center has partnered with clinical experts to implement evidence-based best practice simultaneously with cultural improvement. Methodology: The cultural improvement is based on the Comprehensive Unit-based Safety Program (CUSP) developed by Dr. Peter Pronovost at Johns Hopkins University. CUSP is a five step intervention that includes: 1) education staff on the science of safety, 2) identification of defects, 3) assignment of an executive partner to the unit, 4) learning from at least one defect per month, and 5) implementation of team work tools. At the beginning of a project, and then twelve to eighteen months later, we conduct surveys of the unit culture to identify changes. Results: Over the course of our work we have found clear correlations between irnproved safety culture and outcomes such as infection prevention. The improved culture has also demonstrated sustainability as seen in a median rate for central lineassociated bloodstream infections for a thirty-six month time period in a number of Michigan intensive care units. Conclusion: It is the combination of adaptive work (cultural improvement) and technical work (evidence-based interventions) that holds promise for building capacity for sustainable improvement. The presentation will provide this experience coupled with data from our past and present projects to demonstrate the importance of this combined approach