Latest / The SHEA Podcast / The Business of Infection Control

Transcript

The Business of Infection Control · The SHEA Podcast

• 0:56
  SPEAKER_00: To develop strategy for quality and patient safety and to coordinate health care for the community.
• 1:01
  SPEAKER_00: I will now turn the podcast over to our panelists.
• 1:04
  SPEAKER_01: Hi, I wanted to thank Society of Healthcare Ebrammiology of America.
• 1:09
  SPEAKER_01: And I also wanted to thank Doug Salvador, who's representing hospital administration in this podcast.
• 1:15
  SPEAKER_01: I am Walee Jaweed, and I'm representing hospital epidemiologists in our conversation.
• 1:21
  SPEAKER_01: We have listeners who are practicing hospital epidemiology with various years of experience.
• 1:26
  SPEAKER_01: And even some who are just starting out in the field, with your background and your experience, what should they all know about the way you view the role of the C-suite?
• 1:38
  SPEAKER_02: Waleed, it's a pleasure to be here on this podcast and welcome to all the listeners.
• 1:44
  SPEAKER_02: As a member of the C-suite and a former hospital epidemiologist, I essentially think of the hospital epidemiologist as a member of the physician leadership team within the health system.
• 1:54
  SPEAKER_02: As such, I expect them to have some of the same leadership competencies that department chairs and division chiefs need to be successful.
• 2:00
  SPEAKER_02: We can talk more about that in detail later in the podcast, but some of the important things are collaboration, communication skills, change leadership, and systems thinking.
• 2:10
  SPEAKER_02: Waleed, let me ask you: in your role as a hospital epidemiologist for a large tertiary academic health system, do you feel like a member of the physician leadership team?
• 2:20
  SPEAKER_02: And if so, during which of the activities that you do?
• 2:23
  SPEAKER_01: Yes, so at our hospital, I'm part of the physician leadership.
• 2:28
  SPEAKER_01: This is evident by participation in daily leadership meetings as well as participating in medical board meetings regularly.
• 2:36
  SPEAKER_01: We get in more regularly with medical staff and graduate medical education and shape the educational activities of the entire staff of the hospital.
• 2:46
  SPEAKER_01: All this is done in conjunction with the physician leadership team.
• 2:49
  SPEAKER_01: Really, it's a group effort.
• 2:52
  SPEAKER_01: So, Doug, as a chief quality officer, you report to the Board of Trustees on patient safety issues and participate in planning strategy of the health system.
• 3:02
  SPEAKER_01: What would you say is the importance of infection control and hospital epidemiology?
• 3:07
  SPEAKER_01: Where does it fit in the priorities of the health system today?
• 3:12
  SPEAKER_02: I'm biased, having served as a hospital epidemiologist in the past, but I believe it's one of the core priorities of our patient safety program.
• 3:19
  SPEAKER_02: The attention to hospital epidemiology during my career has certainly been driven recently by two things.
• 3:26
  SPEAKER_02: One, quality metrics and paper performance measures set by CMS and followed by other commercial insurers on hospitals and health systems, and also by the Joint Commission.
• 3:38
  SPEAKER_02: So the Joint Commission surveyors who come through over the last several cycles have emphasized hand hygiene, patient communication about HAI prevention bundles, antibiotic stewardship standards, endoscope cleaning, and equipment reprocessing, to name just a few of the topics.
• 3:55
  SPEAKER_02: And as all of our listeners will know, CMS includes several healthcare-associated infections like CLABC, CODI, surgical site infection, and antibiotic resistant organisms in their pay for performance hospital via-base purchasing program.
• 4:11
  SPEAKER_02: So those measures have become incorporated into our health system objectives on a year-to-year basis where we have targets and an expectation from our board that we make improvements.
• 4:22
  SPEAKER_02: You know, all of our board members are just like us also patients.
• 4:25
  SPEAKER_02: And, you know, many people in the public, as we know, are afraid about contracting infection when they approach health care.
• 4:32
  SPEAKER_02: So our board members are definitely attuned to it, and that's reflected in our priorities.
• 4:37
  SPEAKER_02: One of the things that all boards also care about is the reputation of the health system.
• 4:42
  SPEAKER_02: That starts with the safety and the quality of care we deliver.
• 4:45
  SPEAKER_02: So high-profile breaches and infection control standards that lead to patient harm or having to send out letters to patients, informing them of an exposure and apologizing are definitely all things the boards want to avoid.
• 4:57
  SPEAKER_01: I totally agree.
• 4:58
  SPEAKER_01: And I'll I'll give you a few other examples.
• 5:00
  SPEAKER_01: Whenever there is a breach in infection control practice, it has the potential of causing patient harm.
• 5:06
  SPEAKER_01: As you have mentioned with hand washing, we have all seen reports in recent years with medication compounding, sterilization failures, and exposures to contagious illnesses like measles.
• 5:20
  SPEAKER_01: These are potentially avoidable and require substantial oversight by infection control, as well as working in relationship with all the departments in the hospital.
• 5:29
  SPEAKER_01: CMS surveys are one way government provides this oversight, but within the hospital, the hospital epidemiologists and infection prevention team, infection control team has a heavy lift and has a lot of responsibility to keep patients safe and provide a safe infection-free environment.
• 5:47
  SPEAKER_01: People talk a lot about return on investment and making the business case for infection control, antibiotics, stewardship.
• 5:55
  SPEAKER_01: What do you expect for a business case when hospital immunologists come to you and your leadership colleagues with a request for additional resources for the program?
• 6:05
  SPEAKER_02: It's a great question, Waleed.
• 6:07
  SPEAKER_02: The answer to that question obviously will depend on the organization and the individuals who are in leadership positions.
• 6:14
  SPEAKER_02: For me, I'd say sometimes people spend a lot of time trying to make a financial argument for investment when it's not the most persuasive, or there may not even be hope for a positive financial return on investment.
• 6:27
  SPEAKER_02: So some of the things we do in infection prevention cannot generate a return on investment.
• 6:32
  SPEAKER_02: I think of them as the cost of doing business.
• 6:35
  SPEAKER_02: I remember a few years back someone asking me how to calculate a return on investment for moving to an electronic medical record from paper, and I told them not to bother.
• 6:43
  SPEAKER_02: It's the cost of doing business today, it's a standard.
• 6:46
  SPEAKER_02: So one example of that in infection control would be the resources needed to meet the Joint Commission standards for antibiotic stewardship in that regard.
• 6:54
  SPEAKER_02: So certain functions, certain standards are now considered the standard of care, and we just have to meet them.
• 7:00
  SPEAKER_02: The persuasive effort then becomes about making the case that these resources are necessary to accomplish the functions, that those standards can't be met by simply working smarter with existing resources, and they really require additional support.
• 7:15
  SPEAKER_02: So that's often what I coach people how to make that argument to the rest of our senior leadership team, or when I advocate in support of it.
• 7:24
  SPEAKER_02: I would also like to make the point that in many organizations, and I've been fortunate in the one I work at now and in previous organizations I've worked at, that leaders are often motivated by doing the right thing for patients.
• 7:37
  SPEAKER_02: So I wouldn't underestimate how important it is to make the clinical case.
• 7:42
  SPEAKER_02: When it comes to a business case, we're in the business of delivering health care that keeps our patients safe.
• 7:48
  SPEAKER_02: So sometimes I would turn that around as opposed to trying to define a specific return on investment in dollar amounts and really talk about the improved clinical care that can be delivered, the improved safety, the benefits to that reputation, as opposed to just trying to make a cold dollar calculation.
• 8:07
  SPEAKER_02: So, Waleed, I'm going to change the subject again and ask about your place in the organization.
• 8:13
  SPEAKER_02: When we talk about hospital epidemiologists as physician leaders, who do you report to and which committees do you regularly report in?
• 8:21
  SPEAKER_01: So, as a hospital epidemiologist and in our organization, I report directly to the president of the organization of our hospital and the chief medical officer.
• 8:32
  SPEAKER_01: We have daily leadership meetings where infection control presents their HII numbers and device counts, any pressing issues and answers questions from other department leads.
• 8:44
  SPEAKER_01: This is a really collaborative leadership meeting that we are fortunate to have.
• 8:49
  SPEAKER_01: Our committee reports are submitted to the medical board.
• 8:52
  SPEAKER_01: Other meetings, including HAI reduction meetings bi-weekly or weekly, and then timely root cause analysis meetings of all HAIs when we have any hospital car infections or near misses, are places we we participate in or report out our findings.
• 9:10
  SPEAKER_01: We also participate in incident command structure if issues are related to infections.
• 9:15
  SPEAKER_01: So there are several levels and several meetings that we get involved in and we regularly report in.
• 9:22
  SPEAKER_01: Now I know you have mentioned some leadership competencies earlier.
• 9:27
  SPEAKER_01: When I speak with my boss or report to senior leaders in committee meetings, how do you think I can do most effective job?
• 9:36
  SPEAKER_02: Well, you know, I think that's important.
• 9:39
  SPEAKER_02: I'm going to just stop and react to your last question answer first, and then I'll I'll address that issue of leadership of change.
• 9:46
  SPEAKER_02: So I I think in many ways you're fortunate reporting directly to the president of the hospital.
• 9:50
  SPEAKER_02: And I don't think that there are a lot of our listeners that report directly to the CEO from hospital epidemiology.
• 9:56
  SPEAKER_02: In our organization, our hospital epidemiologists actually reports to the uh chair of the Department of Medicine.
• 10:02
  SPEAKER_02: And I know in others they would report to a CMO or a chief quality officer or other roles like that.
• 10:08
  SPEAKER_02: I would make the point that because this is essentially a role in which as a physician leader you need to have influence over the organization, the exact reporting relationship I think is less important than those horizontal relationships that you can create in the role of hospital epidemiologists with the people who carry influence over change in the organization.
• 10:32
  SPEAKER_02: But I I think you have that support and uh access to those folks and a favorable uh reporting relationship.
• 10:41
  SPEAKER_02: Uh you asked me about leadership competencies.
• 10:44
  SPEAKER_02: I think about leadership of change as a competency needed by all hospital epidemiologists.
• 10:49
  SPEAKER_02: I'll use a couple of examples to explain what I mean.
• 10:52
  SPEAKER_02: When it comes time to influence up in the organization, it's important to know the levers that drive decision making.
• 10:58
  SPEAKER_02: All healthcare organizations have a strategic plan.
• 11:01
  SPEAKER_02: Most have annual operating goals and objectives.
• 11:04
  SPEAKER_02: If you want what you're working on to be visible, it's often a good idea to have some goals and objectives on those organizational or service line or department lists of goals that people pay attention to and work together to achieve.
• 11:19
  SPEAKER_02: In order to make this happen, you need to develop relationships with the right people and understand how the strategic plans and goals are made.
• 11:26
  SPEAKER_02: I always think a good place to start would be making an appointment with the strategic planner and asking how it works.
• 11:31
  SPEAKER_02: One of the things I would look out for in that conversation is what's important to the organization and to individual leaders within the organization.
• 11:40
  SPEAKER_02: An example I mentioned before was boards care about the reputation of the company and CEOs do as well.
• 11:46
  SPEAKER_02: If you're talking to the CNO, they're probably interested in nursing employee engagement as well as clinical outcomes.
• 11:53
  SPEAKER_02: Maybe you work in a magnet hospital.
• 11:55
  SPEAKER_02: If so, when's the next cycle for survey and submission of data?
• 11:58
  SPEAKER_02: Have the nurses chosen any infection rates as some of the quality measures that they promised to achieve targeted performance in when they submitted their magnet documents?
• 12:08
  SPEAKER_02: If so, there's something you can help with.
• 12:10
  SPEAKER_02: Basically, I would look for problems that leaders in the organizations have where you can be part of the solution and offer those solutions up.
• 12:18
  SPEAKER_02: If you're a department chair, you want to demonstrate to your boss that your department is doing its part to deliver safe quality clinical outcomes.
• 12:26
  SPEAKER_02: As a hospital epidemiologist, you can help that chair by providing an improvement project with a plan and support if the chair can offer faculty time to help make it successful.
• 12:36
  SPEAKER_02: Then what's really important is that you give them all the credit.
• 12:40
  SPEAKER_02: Department chairless are also concerned with faculty promotion.
• 12:43
  SPEAKER_02: If you provide scholarly activity and you can help young faculty get involved and get published or submit abstracts or present at meetings, then you're solving a problem for that chair.
• 12:52
  SPEAKER_02: Bottom line, make relationships with these leaders, ask what they're worried about, and bring solutions to them.
• 13:00
  SPEAKER_01: All right, you're making quite a point about developing leadership skills.
• 13:04
  SPEAKER_01: What advice do you have for our young hospital epidemiologists about where to acquire those skills?
• 13:11
  SPEAKER_01: I have a few.
• 13:13
  SPEAKER_02: One point I would make is the technical competencies of hospital epidemiology, working up an outbreak, translating the literature, coming up with new clinical protocols, facilitating a multidisciplinary group of physicians to implement an infection prevention bundle, you know, analyzing literature for policy work, understanding the best practices, are sort of expected at this point.
• 13:37
  SPEAKER_02: You could be the most technically expert epidemiologist, but you won't be able to make change in your organization and therefore be successful without some of these other leadership competencies.
• 13:46
  SPEAKER_02: There are many ways to get them.
• 13:48
  SPEAKER_02: Some of it's related to learning concepts and strategies.
• 13:51
  SPEAKER_02: Those can be learned by independent reading.
• 13:53
  SPEAKER_02: There are books on emotional intelligence, on change management, on leadership in general, and many different individual aspects of leadership.
• 14:00
  SPEAKER_02: It can be hard to sift through this literature though and find out what the best sources are.
• 14:05
  SPEAKER_02: I'd recommend reaching out to a senior physician leader in your organization.
• 14:08
  SPEAKER_02: If your health system has a physician leadership academy, talk to the people who run it and try to get yourself in the next class of learners.
• 14:14
  SPEAKER_02: Find out what their curriculum is and what they're asking their learners to read.
• 14:19
  SPEAKER_02: Your organization likely has a human resources department with people who have expertise in organizational development and leadership development.
• 14:26
  SPEAKER_02: Find them and ask what they would recommend.
• 14:28
  SPEAKER_02: I want to emphasize that you can't become a good leader by reading a book.
• 14:33
  SPEAKER_02: You need to practice these leadership skills and, in my experience, fail many times over in order to accumulate experience to know what will work and what will not work.
• 14:42
  SPEAKER_02: There are training programs which include experiential or project work, and some of this you just need to get out of the office and go try.
• 14:49
  SPEAKER_02: So let me change subjects once again.
• 14:52
  SPEAKER_02: People are often interested in measures of success for an infection control for an antibiotic stewardship program.
• 14:59
  SPEAKER_02: In your program today, Walid, what measures do you follow to prove that your program is doing a good job?
• 15:05
  SPEAKER_01: So our organization sets HAIA targets, which are based on multiple factors, including patient safety, SIRs, previous years performance, and other organization goals.
• 15:17
  SPEAKER_01: Internally, assessing our performance can be a very complicated task.
• 15:21
  SPEAKER_01: It depends on multiple factors that are often dependent on other departments' ability to change.
• 15:28
  SPEAKER_01: And this is where our ability to lead and influence the change, as you have already pointed out, in the organization, takes a central role.
• 15:36
  SPEAKER_01: Overall, year over year, being able to improve, control, prevent, and eliminate infection risk for our patient is the main manure of our performance.
• 15:45
  SPEAKER_02: So when I think about this question at our place, I'll use the example of our antibiotic stewardship program.
• 15:51
  SPEAKER_02: I feel blessed to have what I often call a world-class antibiotic stewardship program at our organization led by Jen Schimmel, who's the medical director, and Erica Hausman, who's the pharmacist leader.
• 16:04
  SPEAKER_02: And you know, when I want to know how they're doing, the big picture measure for me they report out on regularly is the days of therapy per thousand patient discharges within the hospital.
• 16:15
  SPEAKER_02: That number since 2011 has gone down every year up until last year when it stayed flat from the year before.
• 16:22
  SPEAKER_02: Now that the NHSN has a antibiotic utilization and antimicrobial resistance module, we've submitted our data to get benchmarked and we receive a standardized antibiotic administration ratio.
• 16:35
  SPEAKER_02: We've really only been submitting data for less than a year, but we know that it's about 92% of expected, which tells us that we're doing pretty well as compared to with antibiotic utilization as compared to other organizations.
• 16:48
  SPEAKER_02: So I think it's useful to have that kind of a big picture measure, and I think about the total number of catheter-associated UTIs or the total number of collapses across the entire system year over year in a similar vein.
• 17:03
  SPEAKER_02: So, Waleed, I've really enjoyed our conversation today.
• 17:07
  SPEAKER_02: I think it's been great and hope it's helpful to some of the people who've listened.
• 17:10
  SPEAKER_02: Now that you've heard my perspective about how hospital epidemiology fits in the larger quality and safety priorities for an organization, are there things that you'll go out and do differently next week?
• 17:20
  SPEAKER_01: Yes, uh, we have really discussed many important points today.
• 17:24
  SPEAKER_01: And uh I've uh I've noted down a few points.
• 17:27
  SPEAKER_01: Uh uh one is infection control and prevention is part, of course, of doing business for the organization.
• 17:34
  SPEAKER_01: Number two, making a clinical case of patient safety is sometimes far more relevant than making a business case of reduced costs.
• 17:43
  SPEAKER_01: Number three, is hospital epidemiology is the leadership of change.
• 17:48
  SPEAKER_01: And that's a really important point to realize.
• 17:51
  SPEAKER_01: Number four, technical competencies of hospital epidemiology are important.
• 17:56
  SPEAKER_01: And number five, leadership skills can be learned, and one must be prepared to try several different styles, prepared to fail, to learn the best way.
• 18:06
  SPEAKER_01: But the ask of hospital epidemiology is really an ask to lead.
• 18:11
  SPEAKER_01: I really want to thank you and Shay for providing us the opportunity to discuss these important points for our healthcare epidemiology teams.
• 18:20
  SPEAKER_01: Thank you.
• 18:21
  SPEAKER_01: Thank you, Wale.
• 18:22
  SPEAKER_00: Thank you to our panelists for sharing their perspectives and experiences.
• 18:26
  SPEAKER_00: Are you looking to stand your knowledge and effective controls?