Successful CUSP teams. This is based on our years of working with this and out of our Michigan project. They are composed of people that are really engaged. And one of the first things I remember hearing said was from a physician. And after working in the same organization for many years, he said, "You know what? For the first time in 16 years, I'm really excited about being at work today." That's a lot to say that he really felt that there was change, and the change was coming because he had a say in what they were doing, and he really felt that the culture was moving in the right direction. We want to make sure that we have people at all different levels experiencing this and working with this. Remember, we're trying to build capacity for patient safety and quality. And the only way we can do that is to be inclusive and include people at all levels. And I would say all stakeholders need to have a voice. So we bring all disciplines together. We used to call that multidisciplinary care, but we look at it as trans-disciplinary because we want each provider to view the perspective of that other providers. So, a doctor to understand the nurses perspective, the nurses understand the doctors perspective, the respiratory therapist to understand the pharmacist perspective, and so on. Very important that everybody realize that they have the same opportunity to make improvements, and it's not based on your rank or how many years of education you have. It's based on your profession and what you bring to the table. The other thing that we found, the only way this works is that when you schedule a CUSP meeting, you keep the meetings. So you have to meet regularly. In fact, we say one of the first things that you need to do is set up a year of meetings in advance and have adequate resources, including protected time. And this is really hard in difficult economic times, but there's more work to be done than meets the eye. So, a one hour meeting does not give you the time to address all of the things that you do. So let's say one of the defects you've identified is non-compliance with medication in transplant patients. This is something that you're going to spend hours on outside of work. These are times that you should be given opportunities within your workday to do that, and we call that protected time. We found two to four hours for our senior clinical nurses to be very helpful. They got a lot of work done. And that time gets removed if we have low staffing. Other times, if we have low census, we give more people protected time so that we're actually instead of giving vacation time and those kind of things because we don't need the staff. We're saying pick up something that is related to some of the CUSP work that you have and use this time effectively. And the other thing is, share your leadership. So, this is best done if you're not led by a nurse manager or the physician champion. Anybody can lead the CUSP team. And what we really want to have happen is we want to work together to make decisions, so that we don't want somebody that walks in and says, "Well, I'm the chair of this department, but I'm also the ICU director. So I want it done this way." Really, it's consensus building. You're all there to talk about how to best fix the problem, how to best solve the problem. So, nobody gets to trump somebody out if they say, "I have higher rank than you. I have more experience than you." Really, it's an opportunity for shared expression. And that really has to do with how you look at things. So we don't want you to be aggressive. We want you to be assertive. And people that view other people as assertive really respect what they have to say and are happy to listen to them. So, we want them to be engaged and participative. We want everybody's voice to be heard. In fact, we've had to actually go through and say that we're empowering nurses to say what they need to say in some of these meetings and in opportunities when they feel that there patients are at risk. So, remember, you're just one more member at the table and what you say doesn't outweigh what another member says. It's all taken into consideration before decisions are made. The role of your senior executive. So I talked about them a little bit in some of the steps. And what I think is really important about this is when we partner, we are able to achieve a whole lot more. We sit with them. We develop our goals and our strategies for problem-solving. And we really learn a lot from their leadership skill set. So, I've worked with senior executives that are CEOs within my organizations, CMOs. I'm a senior executive for a pediatric unit. I had never worked in pediatrics in my life. And yet there's a lot that we get done. One of the things I think that's really important is people see us as bringing resources. Everybody always says, "Oh, they're bringing resources." Well, resources don't always mean new equipment and money. What it means is that I'm going to show up every month. I'm going to engage with all the front-line personnel. I might even do walk-rounds. So, I'm going to walk around to see how things are functioning on the unit. I'm also going to help you navigate some of the problems. So, I've worked in the organization a long time. If you say, "I know I should be calling clinical engineering, but I'm not sure who I would talk to." So, this is an opportunity for your senior executive to say, "You know what? You need to call John Smith in clinical engineering. He can have this solved for you within 24 hours." The other thing is that they can help you prioritize some of the issues that you've identify that kind of align with your organizational goals. Now, not always will you have adverse events and defects that align with organizational goals, but in the back of your mind, you'll be able to understand the perspective of the organization. And it means much better communication from top-down and bottom-up because normally, top-down gets maybe to middle management but not down to the front-line staffs, and concerns of the front-line staff never get to the top. This is a way that that happens because you're on a first name basis working with somebody that's very high up in your organization. They're always going to connect you with the necessary stakeholders that you need to get the work done. And it's been a win-win situation all the way around. And you don't have to be a clinical provider as a senior executive in order to do a really good job. You just have to care about your organization, providing good care, and making sure that all patients receive safe equitable care. Don't ignore the problems that others don't want to acknowledge. And that is that it always seems like we're being given more work, whether it's a new joint commission mandate or it's a new mandate by our department. We always say that there's not enough time. And every time we get something to do, we look and we say, "Gosh, I have one more piece of paper to file or I have one more application in my electronic medical record that I need to look at." So, not enough time is real, not enough resources might be real. There are some times when resources are the financial kind. They are the equipment kind. In fact, in this program, one of the recommendations were that the CDC recommended that we place central lines with ultrasounds. So, for some of the organizations, it was making a plea to the senior executive or the CEO from that organization or the CFO on how this would benefit the team with placing lines. But sometimes, there are going to be opportunities where there are limited resources, and you have to see what you can do working around it. And sometimes, things don't get done as quickly as possible. But when you're really committed to making sure that harm is untenable and that patients deserve the best care that you got, you're going to find ways to work around that. And I think that it's really important to recognize that protected time really does play a crucial part in getting the work done. The last thing I would like to say, as far as the champions and your executive partner, is that we want to not tackle the biggest problems that we identify first. We really want to look for the low-lying fruit. So, when you're going through your staff safety assessment and you've identified some things that would be really simple to fix, that's what we really want you to look at. Celebrate those early wins, show that you can make a difference in your unit and then move into the more difficult things. There's a whole implementation science behind how we do this. There's a whole quality improvement. There are people that have degrees in quality and implementation. So, as I said, really the CUSP team allows you to build capacity in both of these areas. And I think that's really important. So, celebrate the early successes and move on to the harder things and just keep them on your list because you want to be able to report out at every meeting the progress that you've made and the progress that you still need to make.
