‘UPP’ and Running: Care Improvement Program Melds URMC’s Biggest Priorities

Just a month ago, Strong Memorial Hospital rolled out the “Unit-based Performance Program” (UPP), a major initiative that will—by braiding the three together—help inpatient units better coordinate their improvement efforts around 1) patient safety, 2) the ICARE experience, and 3) operational efficiency.

Pat Reagan Webster, SMH associate quality officer, Quality Improvement, pointed out that safety, great service, and great value absolutely overlap.

“To look at these things independently makes for a false separation of the three,” she said.

Nurse managers and medical directors from all forty-two Strong Memorial Hospital units are leading the program on their units. They’ve sharpened their pencils, sifted through materials, and attended trainings. They’re now busy completing pre-program work—everything from naming UPP liaisons to assessing staff culture (e.g., Do workers on the unit feel valued, and that they can speak up on the job? Believe it or not, this has huge implications for safety.). Next, teams will outline specific challenges to tackle via UPP. The pace will pick up after the new year, as preparations end and all parts of the program, poised and ready, spring into problem-solving action.

“It’s a way to integrate smart safety practices, ICARE behaviors, and lean strategies into our daily work,” Reagan Webster said.

A quick word on those three priorities

Let’s back up a few steps. You’ve had an earful at URMC about patient safety, ICARE, and lean efforts. But why are they so important, and how do they fit together?

Keeping patients safe and satisfied doesn’t require much explanation—they entrust us with their care, and it’s simply the right thing to do. Organizational leanness—waste elimination and aiming for maximum efficiency—sets us up for health care reform, which pressures URMC (and other places nationally) to deliver the safest care and best patient experience at the lowest possible cost. And naturally, our ICARE values help shape the manner in which we deliver care (involving patients and families as partners) and treat one another. Weave together these priorities and we have something stronger than each priority on its own.

Here's where UPP comes into play

URMC doesn’t and won’t let up on its obligation to safety. On the lookout for a way to structure units around the concern, we came upon Johns Hopkins Medicine’s Comprehensive Unit-based Safety Program (CUSP), which empowers staff “to assume responsibility for safety in their environment” by re-molding a unit’s basic culture. URMC Chief Quality Officer Bob Panzer, M.D., and Golisano Children’s Hospital Chief Quality & Patient Safety Officer Michael Leonard, M.D., with help along the way from others, teamed up with Hopkins to adapt the CUSP model for our purposes.

To see what all the hubbub was about, two units here implemented the CUSP model, ending up with fewer C. difficile cases to handle. (C. diff is a bacterial infection that’s growing increasingly problematic on inpatient facilities.) It became evident that a similar program, implemented at SMH, could prove a smart tool for driving the kind of changes that make our hospital a healthier and happier place both for staff to work and for patients to heal.

“Our hope is that UPP isn’t a huge amount of extra work,” said Reagan Webster. “We have all the pieces to count this program among our successes. We already track and scrutinize complications, patient satisfaction, and operational efficiency, for instance. UPP simply wraps a framework around what’s being done. It coordinates efforts across the three improvement foci on inpatient units.”

A massive undertaking? Yes. (Hopkins has 52 participating units—initiated into the program over a span of 10 years!) To say we’re excited that the “UPP-and-coming” program is establishing improved patterns is to put it mildly.

Expect results by March—and, after then, continuing results, as UPP becomes a regular part of the way we do our daily work.

Interested in more UPP info? Drop a line to Pat Reagan Webster, URMC associate quality officer, Quality Improvement.

Jennifer Fortin | 10/23/2013