Comprehensive Unit-Based Safety Program Implementation Into Practice


The promotion of safety for patients is one of the primary goals for clinicians and medical workers. It reflects specific values and norms of communication, as well as error management and transparency (Weaver, Marsteller, Wu, Ismail, & Pronovost, 2017). The Agency for Healthcare Research and Quality offers a variety of practices to achieve improvements in inpatient care, and the Comprehensive Unit-Based Safety Program (CUSP) is one of the available methods. In this paper, the CUSP method, its implementation, and potential barriers will be discussed in order to understand what kind of care can be offered to patients, how healthcare professionals must cooperate, and what training needs to be offered to stakeholders.


Despite numerous attempts by clinicians and other team members, medical and healthcare complications occur. Research continues to investigate what can be done to help patients and healthcare workers, and the CUSP method is an intervention that aims to teach clinicians how to provide safer care through cooperation between doctors, nurses, and administrators (Agency for Healthcare Research and Quality, 2013). It focuses on the elimination of central line-associated bloodstream infections (Berenholtz et al., 2014). There are five main stages in this practice, including educating the staff about the science of safety, the identification of defects in caregiving, the engagement of executive leaders, the possibility to learn from mistakes and defects, and the implementation of various teamwork tools (Agency for Healthcare Research and Quality, 2018a). Each step plays an important role in understanding tasks and promoting patient education.

The characteristics of this practice include the participation of leaders in changes and improvements. Executive leadership affects the safety climate and employees’ perceptions of patient care quality (McFadden, Stock, & Gowen, 2015). In addition, this method endorses safety efforts that are a significant part of any working process (Myers et al., 2017). Currently, about one patient in 10 is in danger of harm while receiving healthcare (World Health Organization, 2018). Therefore, the CUSP practice is an effective intervention for hospitals to promote change in healthcare.

Practice Implementation

The implementation of the CUSP method can be introduced in hospitals in different ways. The main recommendations include the development of a plan and involvement of the whole clinical team – including nurses, doctors, and support employees who understand the goals and work together to achieve positive change and deliver the required outcomes (Ricciardi, 2016). The Agency for Healthcare Research and Quality (2017a) introduces a modular CUSP toolkit with instructional material and key principles that aim to increase safety and promote learning of the basics. The extent to which the practice can be implemented depends on learning CUSP basics, team composition, senior executive engagement, understanding the science of safety and defects, and communication techniques that promote patient and family engagement (Agency for Healthcare Research and Quality, 2017a). Currently, thousands of hospitals in the United States have already implemented the CUSP method. For example, Ali et al. (2014) investigate the results of its implementation to reduce ventilator-associated pneumonia in patients, and O’Brien et al. (2014) focus on the prevention of neonatal catheter-associated bloodstream infections. In both cases, CUSP helps create partnerships, increase support, and improve patient safety.

Barriers to Implementation into Practice

Even though the implementation of the practice is based on properly identified steps taken by people who have already been prepared, certain barriers and challenges exist and have to be overcome. For example, communication determines the quality of care that is offered to patients, the level of team satisfaction, and the rates of nursing turnover (Childress, 2015). In some cases, a clinical team is not able to establish common purposes and divide responsibilities in accordance with their skills and patients’ needs. As a result, a new barrier to the implementation of CUSP arises, and the staff must undergo new training courses to improve their understanding of inpatient care and collaboration (Pitts et al., 2017). Another barrier includes the necessity of finding a leader and making sure that all necessary information is properly exchanged. People need to evaluate their own qualities, investigate the potential of their hospitals or other healthcare settings, and identify the resources available to them at the moment of implementation. Some leaders are not prepared for such a level of responsibility, and some facilities do not have skilled professionals to complete this task.

Ways to Overcome Barriers

Patient safety is a goal that cannot be neglected, and if the use of the CUSP method is hampered by certain barriers, it is necessary to know how to overcome them. Childress (2015) recommends using training interventions where team members can learn more about conflict resolution and changing communication styles to promote and improve collaboration. Pitts et al. (2017) analyze the benefits of the development of communication plans and the use of multiple methods of communication. The Agency for Healthcare Research and Quality (2017a) explains the value of patient participation in healthcare as a chance for clinicians to understand their needs to choose the most effective treatment tools. Instead of merely informing patients about negative aspects of care, a healthcare team must pay attention to patients’ needs. In this way, patients can become valuable sources of information without even understanding that something has gone wrong, or that certain improvements are required. The users of the CUSP model need to demonstrate confidence, support, and respect to their patients and share the information they have obtained. With these guidelines, existing barriers to implementing CUSP practice can be eliminated and patient safety can be improved.

Resources to Inform Transition

Credible sources that can inform the transition to and implementation of the CUSP method in a healthcare setting can be found on the site of the Agency for Healthcare Research and Quality. A number of articles are provided to explain the concept of safety culture and its importance in care by avoiding blame-free environments and developing organizational commitment (Agency for Healthcare Research and Quality, 2018a). Evidence-based reports explain the essence of how health professionals can make the transition and the qualities required of patients, as these are the main decision-makers in care (Agency for Healthcare Research and Quality, 2017b). Communication-based errors can be reduced if medical workers continue learning from the examples of problem-solving in other industries and investigate cases where people apply different skills to gain control and achieve understanding (Childress, 2015; McFadden et al., 2015). All these resources introduce new perspectives for discussion of the main aspects of caregiving and cooperation within a team of medical staff, as well as with patients and their families. The CUSP method is an option that is available to all settings, and it is the decision of leaders whether to implement it or not.


In general, the implementation of the CUSP method that is recommended by the AHRQ team is a significant contribution to the development of high-quality care for patients and their families. Nurses, doctors, and other medical stakeholders can also benefit from this method as it defines the main aspects of their work and introduces a plan. It is not enough merely to open a toolkit and follow the guidelines given. It is necessary to read the background literature and analyze the experiences of different organizations to understand what steps are obligatory in a particular situation. This assignment shows that several resources are available to researchers and policymakers, and the task is not just to make a quick decision, but to weigh all positives and negatives, identify barriers, improve real-life communication and decision-making, and recognize suitable practices.


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