Evaluating the Team and Implementation Factors Associated with Hospital-based Comprehensive Unit-Based Safety Program (CUSP) Team Effectiveness

Embargo until
Date
2017-03-29
Journal Title
Journal ISSN
Volume Title
Publisher
Johns Hopkins University
Abstract
Problem Statement: The Comprehensive Unit-based Safety Program (CUSP) has been successfully implemented in thousands of clinical areas across the United States and around the world and has demonstrated improvements in clinical outcomes, operational outcomes and safety culture. Despite its overwhelming success, some CUSP teams have been more successful than others and the factors associated with success are not well understood. Purpose: The purpose of this dissertation is to examine the team and implementation factors associated with CUSP team effectiveness using a transdisciplinary framework combining team theory and implementation science. Methods: This study used prospectively collected administrative data from CUSP teams from a large, multi-hospital health system. Multivariate linear regression, multivariate logistic regression and multivariate negative binomial regression modeling were used to examine the assocations between CUSP team structures, processes, proximal outcomes (total CUSP projects completed) and the distal outcome of unit-level patient safety climate scores. Results: A total of 88 of 106 CUSP teams had sufficient data to include in this analysis. Compared to teams with champions that received no safety training, teams whose champions received both CUSP basic training and Patient Safety Certificate training had 7.76 greater odds (p=0.07) of having high provider attendance versus low provider attendance. There were significant differences (p=0.02) among unit types (ICU, non-ICU, other) in the odds of having high provider attendance versus low provider attendance. For CUSP teams that met regularly, there was an 8.33-fold increase (p=0.009) in the total number improvement projects completed for every one percentage point increase in the percentage of meetings held. There was a significant association between the age of the teams and total team projects completed with more projects being completed as age increased (Incidence rate ratio (IRR) = 1.003, 95% confidence interval (CI): 1.000, 1.007, p=0.03). Contrary to the hypotheseis, there was significant less improvement projects completed when provider attendance was highest (IRR= 0.59, 95% CI: 0.41, 0.84, p=0.009). There was no association detected between total projects completed (proximal outcome) and unit-level safety climate domain scores (distal outcome). Conclusion: There are several key team and implementation factors associated with CUSP team effectiveness. Unit type is associated with provider attendance, differences exist between hospitals with regard to regular meeting being held, regular meetings and the age of the team were associated with total projects completed while regular provider attendance was associated with less projects completed. More research is needed to confirm these findings and to identify the proximal team outcome(s) that are associated with the distal outcome of unit-level patient safety climate scores.
Description
Keywords
CUSP, Team Effectiveness, Patient Safety
Citation