Engagement of 200 front line individuals in quality improvement partnering with senior administration

47 interventions spanning the entirety of the patient journey

Improved communication and culture change on inpatient floor

New inter-professional rounds that occur 6 times per year

Improved dosing and re-dosing of antibiotics across the department

Improved warming of surgical patients across the department

Improved patient experience scores

Surgical site infection rate drop in Bariatric surgery from 10% to <1%

Discharge rounds that started in Surgery and have spread to the department of Medicine

Frontline teams ingrained in the surgical culture after 3 years

Has transformed quality improvement in our department and the hospital.

Easily adoptable framework that is being adopted by other hospitals.

Quality Improvement in the Department of Surgery was not owned by front line health care providers three years ago at The Ottawa Hospital.  Consequently, there was minimal change.  We decided to use the Comprehensive Unit Based Safety Program (CUSP) to improve both culture and quality in surgery and have created organizational infrastructure to support these teams to ensure this is an ongoing, sustainable system.

We piloted three CUSP teams with a kickoff interdisciplinary grand rounds in general surgery, orthopaedic spine and vascular surgery.   An infrastructure evolved to support our growing number of teams.  We now have 23 teams representing all divisions and areas within the department and perioperative environment and have become recognized leaders in CUSP.  Forty seven unique interventions that have encompassed the entire patient journey have been implemented and we now have patient representatives on our teams.  All interventions have been driven by front line ideas.

The biggest success is that we have gone from minimal front line engagement to 200 individuals being involved with quality improvement.  Successes have ranged from improved communication, better surgical site infection rates, and better processes in areas such as wound care, patient warming and antibiotic dosing.  Discharge rounds from collaboration between surgical nurses and residents was successful on the inpatient general surgery floor and has spread to areas within and outside of surgery.  A conference for education regarding CUSP was organized at our hospital and had 200 attendees.  Recently, every general surgeon at TOH gave up an hour of their operative time to do an in situ simulation to improve team communication in the operating room (a total of 22 one hour in situ simulations were done).  There are many examples that could be used to demonstrate the success of our CUSP teams; one important ’win’ is the fact that CUSP is ingrained in the vocabulary of our front line.  If there is an idea that is thought to improve patient care then CUSP is the forum which is used (we even have CUSP suggestion boxes for people to anonymously have their input).  This culture change is facilitated by our 200 frontline individuals involved on our CUSP teams.

Our department has been transformed by frontline involvement.  With quality improvement being an ongoing journey, we are confident that the infrastructure developed has created an enabling environment in which these teams can thrive and both quality and culture can continue to improve.