During five years at the Stockholm Environment Institute in the early s, he pioneered the concept of preventative environmental management—a core principle of the circular economy framework—outlined in his book Material Concerns: Pollution Profit and Quality of life. Tim has served in an advisory capacity for numerous Government departments, Intergovernmental organisations, non-governmental organisations, private sector companies, and delivery agencies. His work for the SDC culminated in the publication of his groundbreaking book Prosperity without Growth , recently re-published in a substantially revised and updated edition.
In , Tim was awarded the Hillary Laureate in recognition of his international leadership on sustainability. Since then he has achieved numerous radio writing credits for the Radio 4, Radio 3 and BBC World and won several prizes and awards for his work. His plays includes love stories, historical dramas, and a 30 episode environmental thriller. Through drama Tim has helped bring scientific controversies to a wider audience. Additional barriers to successful teamwork include conflict, lack of coordination, misinterpretation of cues, and lack of role clarity.
Disputes are common in groups with diverse opinions, but conflict resolution and team interaction will help strengthen the initiative. Maintaining clear roles and task coordination are also key and will alleviate task or labor duplication, further assisting with the success of the initiative.
When engaging the proposed senior executive member of the CUSP team, the team's progress may be challenged because the senior executive:. These hurdles are external. Many executives can be effectively engaged with the proper technique. Through following the 4 E's Engagement Model, which is explained in the "Assemble the Team" module, CUSP teams will be able to customize their appeal and project approach to meet the needs and clinical background of their executive partner.
When senior executives cite their lack of a clinical background, unit team members can focus their appeal on the fiscal gains associated with patient safety initiatives. If executives are unable to see the value of CUSP for the unit or the hospital, unit team members should relate success stories or real data that highlight the triumphs other unit teams have experienced when implementing CUSP initiatives in their units. If executives claim a busy schedule as a barrier to involvement in the project, the team can arrange monthly meetings via conference calls.
At any given time, there are several system factors that simultaneously influence unit culture and patient safety.
Born on the Zodiac Cusp
Patient characteristics, such as medical history, acuity, primary language, or ability to participate in the development of the care plan can influence patient safety. In addition to patient characteristics, task factors can shape the delivery of care and patient safety in the unit. Patient complexity influences both providers' ability to meet patient needs and their capacity to manage the task of care.
Providers should understand the relationship between their own knowledge, skill, and attitudes, and how these may benefit or detract from the quality of care that patients receive. Providers should be comfortable speaking up if they are not in agreement with task assignments and protocols or when they see patient safety risks. Evidence suggests a direct relationship between some patient outcomes and the willingness of staff to speak up.
Team factors may involve issues with teamwork, communication, inadequate supervision, and training.
Noisy, dirty, distracting, and poorly lit work environments can wreak havoc on the delivery of high-quality patient care and should be addressed when attempting to diagnose system-level influences on patient care. When staffing issues, admission policies, and protocols prove to be insufficient for the needs of the patient and provider, they will affect the quality of care.
Staffing and coverage shortages cause patients to suffer through missing the attention necessary to recover. Additionally, staffing and coverage issues can increase the likelihood for medication or health care procedure errors, downgrading the type of care patients receive.
Kits – CUSP Pittsburgh
The type of facility and budget limitations may adjust a patient's care plan. While these factors are the furthest removed from the patient, they continually alter care delivered during hospital recovery. When identifying defects that affect patient care, knowing how a defect will affect patient safety can help the team prevent the defect as well as a sentinel event. In doing this, providers understand the relationship between production pressures and defects in the health care system in addition to the intended outcomes that these can produce.
Examples of defects or errors that affect patient safety, and the interventions to alleviate them include:. Communication problems are cited as the root cause of most errors in studies by the Joint Commission and others.
Several elements affect communication and information exchange, such as:. A Just Culture learning environment allows the review of both system design and the employee's choice of behavior in response to assigned duties.
Latest available findings on quality of and access to health care
It provides a comprehensive process to investigate harmful events or patient safety concerns and determine an appropriate course of action with the employees involved. Just Culture principles are a crucial accompaniment to the CUSP framework and will spark the shared accountability that is necessary for CUSP implementation to be successful. David Marx developed the Just Culture framework based on risk management concepts from high-reliability industries, such as aviation and nuclear energy.
A Just Culture is a system that holds itself accountable, holds staff members accountable, and has staff members who hold themselves accountable. Shared responsibility is the norm in a Just Culture, and a commitment to eliminating the possibility of error is widespread within a Just Culture. The CUSP model generates measurable results. Overall mean safety climate scores significantly improved from CUSP implementation and the improvements in workplace culture that it brings also make technical improvements in care possible. All of these units implemented CUSP, and many continue to see rates at or near zero over extended time.
Culture change is hard work.
CUSP Early Entrance Experience
As you complete the adaptive work of improving patient safety and confront challenges that will seem messy and intractable, keep your eyes on the prize and remember that in thousands of units all over the country, CUSP has brought measurable results. CUSP will help unit teams achieve:. CUSP integrates with and supports a broad range of quality and safety improvement models. As teams use CUSP and its tools, they should look at resources already in place and enhance the projects by combining them in efficient and effective ways. People across an organization, and team members of any discipline or rank, can use the CUSP Toolkit and expect measurable results.
Any implementation of CUSP will bring with it certain challenges. In confronting these challenges, often concentration on a specific module or tool in the CUSP Toolkit will help overcome obstacles. For example, the Staff Safety Assessment can help to pinpoint the particular needs of specialty units, and the Shadowing Another Professional tool can trigger greater participation from your senior executive partner and physician champion. CUSP is an investment in time, energy, and dedication that brings both tangible and intangible benefits. When CUSP tools become integrated into routine daily and weekly workflows, the process of improving safety will become a recognized complement to the process of care delivery itself.
CUSP implementation can lead to improved safety and improved staff satisfaction and retention.
Search ahrq. Latest available findings on quality of and access to health care. Find collaborators, grants, and publications at Columbia. A: Grant information is automatically fed from Columbia University administrative databases. Publications are retrieved from PubMed. Grants and publications are updated in CUSP on a monthly basis. A: Grants may be missing for several reasons.
Grant information is updated in CUSP on a monthly basis.
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If your grant is new, it may not yet be reflected in the information retrieved from Columbia University administrative databases. Some Columbia faculty members submit grants through entities other than Columbia University e.
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