From left to right: Dorothy Larson, Sandra Velte, Diane Koch, OneTogether mascot, Lisa Forsell, Craig Wallace at IAHCSMM 2013 Annual Conference, following Educator's Forum.
By Peter Holbrook
Healthcare professionals around the country are rallying to reduce infection rates by promoting sustained behaviors, fostering a shared sense of purpose and empowering individuals to make a difference at every level of care. The new initiative, called OneTogether: The Power of Small Actions, aims to reduce the incidence of healthcare-acquired infections (HAIs) by increasing awareness of how the small, individual actions of every healthcare worker can have a profound influence on patient health and safety. While no one can discount the benefits of modern science, some of the most significant advances in human health have as much to do with human behavior as they do with technology. And OneTogether seeks to harness the power of people to further reduce HAIs.
Susan Morabit, infection preventionist at WellStar Kennestone Regional Medical Center in Marietta, Ga., put the OneTogether principles to work at her facility soon after learning about them at last year’s 3M Infection Prevention Leadership Summit. “The whole concept is so simple and yet so powerful,” she says. “It’s basically about recognizing that even small actions can make a huge difference to patient well-being.”
Caught in the Act
Morabit adopted one of the first tactics devised for the OneTogether program: a set of wallet-sized thank you cards tailored for specific job functions, from sterile processing to housekeeping. These cards recognize the important contributions that employees make every day to help prevent HAIs. Messages express appreciation for following policies and procedures, adhering to dress codes, using hand sanitizer and even for reminding practitioners, patients and family members to use infection prevention best practices.
“I like to hand out the cards the moment I catch someone in the act of doing the right thing, because it has so much more impact,” she explains. “It only takes a few seconds to use hand sanitizer, and only a few seconds to thank someone for doing it. But those few seconds can really help that person feel they’re making difference in our patients’ lives.”
OneTogether was subtitled “The Power of Small Actions” for a very big reason. Jan Lienau, infection preventionist II at Greer Memorial Hospital in Greer, S.C., explains: “Something as small as taking the time to clean a corrugated bedrail can prevent a patient from contracting a surgical site infection, if the previous bed occupant had MRSA, for example. That extra minute can really change the course of recovery for the next patient.”
OneTogether’s emphasis on the power of small actions is especially welcome, adds Morabit, in light of the changes in the healthcare industry and the increasing pressure on staff and providers. “Healthcare has become so task-oriented that it can be hard to make the connection between procedures on a checklist and their impact on patients’ lives.”
Part of the challenge lies in healthcare workers’ preconceptions about their own fields. While departments such as Environmental Services, Facilities Engineering and Patient Transport are instrumental in keeping patients safe, employees may not recognize how their contributions affect patient outcomes. Lienau hopes that OneTogether can help change that. “Infection prevention is not just my job or your job,” says Lienau. “It’s everyone’s job. We all have an effect on every patient.”
Mike Lamoreaux, manager of environmental services at the Utah Valley Regional Medical Center in Provo, Utah, agrees that OneTogether is helping to change perceptions, particularly for employees not directly involved in patient care. He is responsible for 160 staff members who clean patient rooms and common areas, wash linens and safely dispose of waste.
According to Lamoreaux, the idea that environmental services is a partner in infection prevention is a relatively new one. “Housekeeping work is still widely undervalued,” he says. “I want to change the culture so our staff are considered to be healthcare workers – not a maid service. Because without us, without a clean environment, the nurses and doctors couldn’t accomplish the things they do.” This includes changing the perceptions of his own staff. “Instead of thinking that ‘my job is cleaning and emptying the trash,’ we want them to think, ‘I’m preparing the OR suite for an operation.’”
Changing Minds, Changing Lives
So how do you change people’s perceptions? While group training, seminars and other mass approaches play an essential role in the process, Lamoreaux, Morabit and Lienau maintain that the most effective and longest-lasting way is by reaching out to one employee at a time.
They all have each adapted the OneTogether thank-you cards for use in their facilities as a way to encourage best practices and engage employees. Lienau and Morabit carry these cards on their daily rounds and hand them out when they observe an employee complying with good infection prevention practices. They also enter these employees in a monthly prize drawing – but it’s the one-on-one encounter itself that has proved the most motivating. “It makes their day,” says Lineau. “They really brighten up. Because it’s so nice to hear ‘You’re doing a great job – and an important job.’”
These unexpected moments have a profound impact on employees in every function, including jobs such as environmental services and patient transport where many of the employees are non-native English speakers. “Most of the time those employees feel unseen, invisible,” says Morabit. “When someone notices them and the good work they are doing, they begin to feel like they are part of the team.”
Lamoreaux also uses the cards to spur conversation. “People often ask me, ‘Why are you thanking me for keeping patients safe?’ And that opens a door to dialogue,” he says. At Utah Valley Regional Medical Center, OneTogether parallels an existing corporate-wide HAI reduction initiative called Target: Zero. As part of this program, environmental services and OR staff have collaborated to reduce surgical site infections. Between Target: Zero and OneTogether, Lamoreaux has seen a positive change in the way Environmental Services staff approach their jobs. “The issue of HAIs is made up of so many pieces that communication and collaboration is the only way to attack it,” he says. “Working together with the other departments on this issue has opened their eyes to the work we do. And it has helped Environmental Services employees take more pride in their work, knowing that what they do makes a difference.”
This greater sense of pride and purpose not only improves employee morale, but also translates to a renewed commitment. “It gives people a sense of ownership,” says Morabit. “Healthcare workers who realize the full extent of their influence on patient health take that responsibility seriously.” She adds that, because people respond better to positive recognition than criticism, even a simple thank you card can serve as a driving force for change. “I can acknowledge a staff member who does a good job but has some room for improvement,” explains Lineau. “By recognizing what they’ve done right, it makes them strive even harder to do great work.”
The Power of Small Actions
The potential of OneTogether is being further developed. Lamoreaux plans to expand his program next year, leveraging his facility’s Target: Zero campaign. Morabit wants to feature the program in the WellStar system newsletter in order to elevate the infection prevention conversation within the broader healthcare community. And Lineau is working with her OneTogether counterparts to expand the reach of the OneTogether program into her region’s large hospital associations. According to Lineau, this flexibility is part of what makes OneTogether so successful: “Positive recognition is something you can do independently, autonomously. You can morph the program into whatever best fits your facility.”
Around the world, OneTogether participants continue to share insights on the OneTogether LinkedIn forum, collaborating on new strategies and resources and spreading the word that small actions can make a big difference. And that message resonates with healthcare workers, regardless of field or background. As Morabit notes, “One little thing that may be insignificant in our daily routine may mean the world to someone else. Taking just one extra minute – whether to clean one’s hands, wipe a railing or simply say thank you – has the power to change the lives of both healthcare workers and patients alike.”
Healthcare workers hold the trust – and the lives – of patients in their hands, each and every day. And every small action can potentially change the course of someone’s life. Ignited by 3M Infection Prevention in conjunction with founding partners Association of periOperative Registered Nurses (AORN), International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Surgical Infection Society (SIS), Association for the Healthcare Environment (AHE) and Practice Greenhealth in the United States and the Royal College of Nursing (RCN), Association for Perioperative Practice (AfPP), Infection Prevention Society (IPS) and College of Operating Department Practitioners (CODP) in the United Kingdom, the OneTogether initiative represents a collaborative, grassroots approach to creating safer healing environments where HAI no longer threaten the most vulnerable. The program acts as a forum for healthcare workers from every discipline to share ideas and collaborate in new ways to reduce the incidence of HAIs.
Peter Holbrook is a St. Paul, Minn.-based business writer and owner of Holbrook & Associates.