Building Your SUSP Team Part II

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Learning Objectives

• Define your SUSP team composition and roles and responsibilities of team members

• Discuss the role of the executive partner on your SUSP team

• Plan for initial SUSP team meetings

• Define the project ‘pre-mortem’ process and how to use it.

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The Peri-operative SUSP Team

• Understands that patient safety culture is local

• Is composed of engaged frontline providers from pre, intra-, and post-operative care areas who take ownership of patient safety

• Includes staff members who have different levels of experience and perspectives

• Meets regularly (weekly or at least monthly)

• Has adequate resources including protected time– 2 to 4 hours per week for a team leader, surgeon,

anesthesia, nurse, and infection preventionist

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SUSP Team Members

Essential Team Members• Surgeons• Anesthesiologists• CRNAs• Circulating nurses• Scrub nurses / OR

techs• Perioperative nurses• Executive partner• Nurse leaders

Enhancing Team Members• Physician assistants• Nurse educators• Anesthesia assistants• Infection preventionists• OR directors• Patient safety officers• Chief quality officers• Ancillary staff

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Summary of points to consider in team formation

• Team composition: Are we set up for success?– Group size– Skill mix (technical expertise, interpersonal skills)

• Team processes: Do we interact effectively?– Communication– Leadership– Education– Conflict management

• Team norms: What are our values?– Mutual trust and respect– Inclusivity– Transparency

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Getting team composition right: SUSP Team Membership Form

Establishing clear roles & responsibilities: SUSP Team Formation Worksheet

7Armstrong Institute, 2012

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Engaging Executive Partners

Identify an appropriate executive partner

• Contact hospital management to determine which senior executive will best fit the unit and the following criteria:

– Director level or above

– Available to round for at least one hour per month

– Approachable and comfortable with sensitive topics

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Engaging Executive Partners

Meet with the senior executive to secure his/her commitment

• Senior executive participates in the Science of Safety Training

• Schedule a Kick-off Meeting

– Schedule the senior executive for 1.5 hours to ensure he/she has plenty of time to spend with the team

– Align priorities and gain buy-in

• Attend monthly SUSP meetings

– One-hour meeting, on the unit, half of time spent meeting, half of the time interacting with caregivers on the unit

Executive Leader’s SUSP Team Role Checklist

Education

• Ensure science of safety training for all current and new employees

• Foster organizational learning: disseminate learning from defect lessons with expectations for local adaptation

Executive Leader’s SUSP Team Role Checklist (cont’d)

Policies and Procedures

• Create a policy for unit level accountability: document learning from at least one defect per quarter

• Assess and improve usefulness of briefing and debriefing

– Quality of implementation– Surfacing and resolving defects

Executive Leader’s SUSP Team Role Checklist (cont’d)

Acknowledge work of teams

• Celebrate success through stories in hospital newsletter

• Opportunities for teams to share with management and other teams

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Sample Agenda Items for Your Initial SUSP Team Meetings

• Clarify goals and vision for the team and project– Is it clear and compelling to everyone?

• Define roles and responsibilities– Does the team have all essential team members?

Complete the SUSP Team Formation Worksheet

• Discuss a communication and engagement strategy– How will you communicate your vision and engage

others to participate?

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Sample Agenda Items for Your Initial SUSP Team Meetings (cont’d)

• Plan your strategy for educating staff on the science of safety– How will you ensure everyone can have access to the training?

• Plan your strategy to administer your staff safety assessment– Should be done after the Science of Safety with clearly defined timeline.

Staff safety assessment can be administered right after the Science of Safety training.

First give team Vision then Voice

• Develop a plan for SUSP team interactions– What will your meeting schedule look like? How will you communicate in

between meetings?

• Discuss safety culture assessment– Has one been conducted in the previous 12 months?

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Sample Agenda Items for Your Initial SUSP Team Meetings (cont’d)

• Conduct a project ‘pre-mortem’

– What are the major obstacles to success and how can you proactively overcome them?

The Project Pre-Mortem

• In a postmortem, an autopsy is performed to learn why a patient died.

– While it may be helpful to those who perform it and hear about the results, it does not help the central figure in the medical drama—the patient.

• The PreMortem Exercise is used to identify potential barriers and vulnerabilities to project success before they occur.

– It builds intuition and sensitivity to future problems.

Pre-mortem: Step 1

• Imagine that we are 1 year into the future and, despite all of the team’s efforts, the project has failed—catastrophically. Things have gone completely wrong on a number of fronts.

• Now, ask: – What does the worst case scenario look like?

Pre-mortem: Step 2

• Generate the reasons for failure.

• Spend the next 10 minutes writing down all the reasons you believe this failure occurred.

• Now, ask: – What could have caused our project to fail

Pre-mortem: Step 3

• Prioritize your list of potential reasons for failure.

• Address the top 2 or 3 items from your list that are of greatest concern.

• Now, ask:

– What specific actions can you take to avoid or manage these issues?

Pre-mortem: Step 4

• Throughout your project, periodically review the potential problem list to remind yourself and the other team members of problems that may be emerging.

Pre-mortem Summary

• Step 1: Two years out, what does the worst case scenario look like?

• Step 2: What could have caused your project to fail?

• Step 3: What specific actions can you take to avoid or manage these issues?

• Step 4: Review and resensitize yourself to potential problems throughout the project.

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Action Items

• Actively engage your executive partner

• Schedule and hold your first SUSP team meeting (if you haven’t already). Make sure to address:– Project vision, goals, and expectations

– Team composition and roles and responsibilities

• Conduct a project pre-mortem (second meeting)