[MUSIC] In this video, we'll continue talking about our practical model for translating evidence into practice. And specifically, we want to focus on getting the science right. We previously shared with you some of the lessons learned from our efforts to apply the translating evidence into practice model working with thousands of hospitals across the country for the prevention of healthcare associated infections and other preventable harm. And we've learned that much of this harm, indeed, is preventable, and that they need to be viewed as a defect within our healthcare system. We learn that to be successful, we can't focus on individual providers, asking them to try harder or to be more vigilant. But rather, we need to focus on the system of care within our organizations, because every system is perfectly designed to achieve the results that it does. And we've talked about how this effort is much more complex than simply implementing a checklist. To be successful we need to do a better job of engaging our frontline staff to identify and to fix these local defects. For any quality improvement effort there are two really important areas that we need to get right. The first was what we would call the technical work. The second is what we would call the adaptive work. The technical work is that long list of evidence based therapies that we know that patients should receive. For many healthcare organizations, we work for decades to try to incorporate these evidence based recommendations into a number of checklists, and policies and protocols, trying to make it easier for providers to do the right thing. But there's also, importantly, that adaptive work. Adaptive work is that intangible component of work, like ensuring team members speak up with concerns and hold each other accountable. What happens within your organization if somebody's inserting a central line? You're using a central line insertion checklist, but yet providers aren't complying? Is that nurse comfortable speaking up to remind the provider that they've missed an important evidence based therapy? Or what happens within your organization if a frontline staff member watches another person not wash their hand after they've had contact with a patient? Is that provider comfortable speaking up? If providers do speak up, what kind of response do they get? Do they get words of encouragement, like thanks, I really appreciate that reminder. Or more often, unfortunately, do they get a scowl and are providers angry that they've been reminded? It's this adaptive work or the values, attitudes and beliefs on behalf of our frontline staff that are exceedingly important and play an important role in the success of any quality improvement program. To be successful, we need to get the balance between this technical work and this adaptive work, both have underlying science, we need to get that science right. We know that there have been some epic fails in healthcare policy related to just focusing on the technical work. We know for many years now organizations have required us within in hospital, as well as the outpatient setting, prior to any surgical procedure, thou shalt stop and verify that we have the right patient, the right procedure and the right side. But yet, unfortunately, we now know that this universal time out has done little to nothing to prevent wrong sided surgeries in this country. Far too often, our efforts focus just on the technical work like implementing a checklist, when we don't spend enough time beginning to address some of the values, attitudes and beliefs, or the adaptive work, within our organizations. And we know that this adaptive work, by far, is equally as important, if not more important, than the technical work in the success of a quality improvement project. In future videos, we'll talk about our approach to addressing this adaptive work called the Comprehensive Unit-based Safety Program, or CUSP. CUSP is perhaps one of the most successful and validated approaches to address frontline teamwork and safety culture within our organizations.
