IP Stakeholders Series: Patient Safety and Quality

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By Kelly M. Pyrek

The concept that infection prevention and patient safety is everyone's responsibility is nothing new, but some healthcare institutions may still be struggling to foster and nurture a culture of safety that permeates every department and every function. Taking the lead are directors and managers in patient safety and quality improvement, but infection preventionists (IPs) must also retain a prominent position as stakeholder in the process.

Stacy Martin, infection prevention manager for Moffitt Cancer Center, says her department has a collaborative relationship with the patient safety leaders and emphasizes, "In my view, infection prevention is one specialized facet of patient safety. Both areas share the same goal of establishing and maintaining a safe environment and support safe care of patients." 

It's a message that resonates at other healthcare systems.

Randy Harmatz, chief quality officer at UF Health Shands, says that "Patient safety is a team sport and at UF Health we have been actively fostering our culture of safety and have rolled out Just Culture training across our institution."

In terms of the benefits of a culture of safety, Harmatz indicates improved outcomes, improved compliance with infection control best practices, as well as intense and constant focus on infection prevention. "We are one of only a few AMCs that have avoided the CMS HAI penalty for the past 3 years and we believe this is a direct result of our inter-disciplinary approach and constant attention to prevention," Harmatz says.

A "Just Culture" is based on the tenets expressed by Marx (2001) that encompass creating an open, fair and just culture; creating a learning culture; designing safe systems; and managing behavioral choices.

As well, communication and collaboration are the foundational aspects of a culture of safety in healthcare institutions, and it may be a challenge to achieve adequate dialogue between hospital infection preventionists and patient safety/quality) leaders. The key might be a regularly scheduled meeting of the minds.

"At UF Health Shands, there is regular and constant communication between the hospital infection preventionists and the quality/patient safety office," Harmatz says. "An inter-professional team meets weekly that includes quality, nursing, infection prevention, laboratory, environ-mental services, hospital epidemiologists and supply chain to review every reported HAI to determine if there was something that could have been done to prevent the HAI. In addition, there are multiple Infection prevention PI teams where quality and IPs are at the table. We also have a team of hospital epidemiologists that work in lock-step with our IPs. This approach has resulted in improved outcomes, as preventing harm is one of Quality Big Aims." 

Infection preventionists should trust that they are a valued member of the patient safety team, and they should use their position as such to ensure the needs of their programs are met as a way to support quality and safety initiatives. As Harmatz notes, "We have a proactive and collaborative infection prevention department with excellent leadership. Perhaps the biggest challenge is making sure the IPs have the time to round on the units to provide support and feedback to our care givers. By meeting regularly, we have established good channels of communication." 

Martin echoes that sentiment. "Competing priorities for time and resources are the biggest barriers I see.  Both departments are under pressure to improve patient outcomes and it becomes very difficult to be all things to all causes.  With the increasing number of outcomes measured and reported, I think it is difficult for organizations to focus and truly succeed in improving one issue before another is competing for attention. Communication is the key.  I believe the departments need to have opportunity to discuss overlapping priorities and projects. At our hospital, infection prevention attends the safety and quality meetings to update each other on current issues and successes."

As an IP, Martin faces daily challenges to conquer. "Hand hygiene monitoring is an issue that patient safety and infection prevention are facing together," she says. "Both departments are sharing in the responsibility for monitoring as well as opportunities to perform in-the-moment corrections.    The plan is that this helps spread the message that hand hygiene is not only an infection control issue, but it is a patient safety issue."

Jodi Joyce, BSN, RN, MBA, CENP, NEA-BC, FACHE, associate vice chancellor for quality and patient safety at the University of Illinois Hospital & Health Sciences System, points to the fact that over the last decade, infection prevention has gained prominence in many healthcare organiza-tions’ patient safety efforts. Joyce explains that UI Health's Quality and Patient Safety Division is comprised of four teams:  Accreditation & Clinical Compliance; Quality Performance & Improvement; Patient Safety & Risk Management, and Infection Prevention & Control. "This means that our infection preventionists are core members of the team and considered patient safety leaders in their own right," Joyce says. "To facilitate adequate dialogue and collaboration, our infection preventionists regularly spend time in all of our clinical areas, which makes them available to answer questions and help problem-solve infection-related issues.  We also make sure our quality and safety improvement teams include infection preventionists; two current examples are our Blood & Marrow Transplant Unit Infection Prevention workgroup and our Optimizing Surgical Outcomes workgroup.

Joyce emphasizes that "Infection preventionists are a vital part of our quality and safety efforts at UI Health." She adds, "They help educate clinicians, patients, and visitors on infection risks and how to mitigate them; develop policies, processes, and tools that help ensure safe care; assist in identifying and disseminating best practices – both from within UI Health and from other leading healthcare organizations; and provide assistance and expertise to clinicians who are managing complex patients and clinical situations. With their leadership, support, and expertise, UI Health has achieved a 58 percent reduction in central line-associated bloodstream infections (CLABSIs), a 43 percent reduction in catheter-associated urinary tract infections (CAUTIs), and a 28 percent reduction in surgical site infections (SSIs) since December 2012."

Joyce adds, "Infection preventionists are best suited to drive and promote their specialty because they are the experts. While familiar with the quality models and leading change, the knowledge an infection preventionist has regarding prevention of infection is like no other in the organization.  This specialty is gaining more recognition as the stakes for producing optimal patient outcomes becomes higher and higher for the organization.  It was once uncommon for the C-suite to know the IP at his/her organization but I would venture to say that most now know them by name and refer to them on a regular basis."

Despite progress and continual improvement, real life gets in the way and barriers to communication and collaboration can exist and persist. Harmatz says these barriers be broken down through education. "As a large Academic Medical Center, we have a large and often mobile workforce (i.e., residents, etc.)," Harmatz explains. "Through our Housestaff Quality and Patient Safety Committee, we have established a standardized education program on infection prevention that has yielded good results. Infection rates are broadly shared across the institution, which has helped raise awareness and foster communication.
 Joyce acknowledges that processes and even the physicality of the healthcare institution can serve as barriers. "Sometimes, very simple is-sues can pose barriers to communication and collaboration across disciplines," Joyce says. "For example having offices in separate buildings, having different clinical schedules, operating with a 'departmental' instead of an 'interprofessional' focus."

Joyce says UI Health believes that the solutions to effective communication and collaboration include:
- valuing the complementary skills and expertise that ALL of UI Health’s team members bring to the table
- ensuring infection preventionists are on our quality and safety workgroups
- making sure they spend time with, and are consistently available to, clinical and operational leaders and staff to answer questions and pro-vide assistance
- having specific annual organizational goals related to reducing infections and infection-related risks
- being “transparent” and inclusive about performance

"We distribute a dashboard and detailed reports to all clinical and operational leaders every month, which they in turn share with their teams; we also make data easy to access on our intranet," Joyce explains. "At UI Health, we are committed to a culture of safety – a commitment to both safe patient care and a safe work environment.  Starting with our CEO and the rest of our senior leadership team, we believe that every leader at UI Health is accountable for supporting and improving our organization’s safety culture and safety performance. We encourage every employee to share ideas on how to make our care processes and our workplace safer, and our policies and practices have been designed with safety in mind. Our infection preventionists are playing a crucial role in this important work, and we look forward to their continued expertise and contributions as we make further improvements in the care that we are providing to our patients."

Reference: Marx D. Patient Safety and the Just Culture: A Primer for Health Care Executives. Columbia University. April 17, 2001.