Moving on from CUSP to CUP: empowering multidisciplinary teams and integrating them in the management structure of hospital organization

Background: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a “systemic” requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities. Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.