The 3 C’s: Collaboration

Collaboration is one of the 3 C's of effective infection prevention.

I vividly remember this moment from when I was 6 years old. My dad was pushing me on the backyard swing when he said, “Heather, did you know that you can do anything you want to? If you put your mind to it and you work hard, you can do anything.”

His words stuck with me throughout my childhood and into adulthood. They gave me the motivation to chase after my dreams and passions. Today, I repeat the same words to my children with a fervent hope that they too will reach for the stars. However, I now know something that I did not know when I was 6 years old. I cannot, in fact, do everything. Dad, I know you’re reading this. And I’d just like to point out to you that, despite my willingness, it is still physically impossible for me to lift a 90-ton stone 500 feet into the air and construct a pyramid. However, it was seemingly equally impossible for the ancient Egyptians, yet somehow they accomplished it. Scientists have long speculated about how the pyramids were built, but one thing is certain: No one did it alone. As it turns out, alone we cannot do everything. But together, our efforts have immense potential.

For the past several months, we have been exploring this concept of the 3 C’s: Connection, Communication, and Collaboration. In the work we do as infection preventionists (IPs), these C’s are essential to ensuring that our words are not only heard but listened to and acted upon. (If you haven’t had an opportunity to read about connection and communication, be sure to check out the first 2 C’s.) This month, let’s dive into discussing the last of the 3 C’s, Collaboration.

Collaboration refers to the practice of working together to achieve a common goal. As IPs, we have an endless list of goals. We want to decrease our central line–associated bloodstream infection rates, improve environmental cleaning, increase adherence to hand hygiene, identify the source of an outbreak, and more. Although we have numerous strategies for improving prevention and control in our facilities, all too often these strategies fall short of succeeding. Why? One simple reason is because even when you are an excellent communicator and connected with the teams you seek to influence, without collaboration all your hard work will never achieve the desired outcome. We do not know everything, and we cannot achieve everything on our own. I may be an exceptional emergency department nurse, but my skills and knowledge are not those of an operating room (OR) nurse. Still, I have spent a considerable amount of time working as an IP in the OR, and my time there was highly successful. I was not, however, successful because of anything I did alone. Rather, I was successful in achieving my goals because I was committed to partnering with the OR teams that I worked with. It was together that we realized our objectives.

Paul E. Farmer, MD, PhD, an American medical anthropologist and physician, once wrote that “with rare exceptions, all of your most important achievements on this planet will come from working with others––or, in a word, partnership.”1 Farmer discovered, as have countless others, that when seeking to achieve a goal, it is always best to work together. Every individual has a gift, a strength, a perspective. It may not be your perspective, strength, or gift, but that’s the point. It is by working together that we can achieve so much. Collaboration will often result in better outcomes and ideas simply because of the collective knowledge obtained from the partnership. I have never been able to solve an outbreak, improve infection rates, or write a policy entirely by myself. I have always relied on the perspectives, the strengths, and the gifts of others.

Not only will we accomplish more and go farther when we work together, but the goals we complete will be more sustainable. When I find that my children’s bathroom is dirty, it is much easier for me clean it myself. However, if I teach them how to clean it and develop a schedule for cleaning it, the bathroom will stay cleaner over time. In the same vein, all too often we seek to make changes without consulting our health care teams on the best methods for implementing and sustaining those changes. Sometimes, instead of taking the time to put sustainable processes in place, we take the easier route of doing things for our teams. During an IP’s performance improvement assessment, I asked her, “Who restocks the disinfectant wipes when they’re empty?” She proudly replied, “Oh, I do that!” But when I asked what happens when she is not there, she did not have an answer.

We cannot sustain improvements and changes alone. We must collaborate with— and rely upon—the collective knowledge and efforts of our teams. Changes are more sustainable when individuals have had a part in developing and applying those changes. Collaboration then leads to sustainability. Sustainability does not happen when we come into an area and try to fix problems or do the work ourselves. Sustainability happens when we partner with others to identify system-level problems and develop and implement solutions together.

Collaboration: The Last of the 3 C’s

Collaboration is the last of the 3 C’s for a strategic reason. Before developing a partnership with a group of individuals, we must first be able to effectively communicate and connect with them. They will be more likely to listen to what we have to say and be open to partnering with us when we have established good communication and connections with them. But practically speaking, how do we collaborate with the teams we seek to influence? Here are a few suggestions to get started:

1. Humbly ask for help to identify problems. When infection rates increase and an investigation ensues, call upon members of the team to assist in the investigation. Ask “What do you think is happening here?” I am always impressed by the transparency and knowledge of the health care team when I ask this question. Their information is incredibly insightful and often points me in the direction of a source or a solution.

2. Do not arrogantly assume that you know everything. This is an important life lesson that also translates well in the work we do as IPs. I do not walk into someone’s home and diagnose a problem with their plumbing. I first ask them what the problem seems to be and then I seek additional help in areas I do not have sufficient knowledge in, such as plumbing. As an IP, you will identify problems that you cannot fix alone. You will need to rely upon the expertise of individuals in engineering, environmental services, sterile processing, and other areas to help you identify sustainable solutions. Know enough to know that you will never know everything.

3. Identify individuals who are passionate about prevention. Often referred to as infection prevention champions,2 these individuals are front-line staff who are particularly interested in a specific area of prevention. They can promote prevention on the front lines and are often relatable and listened to by their peers. Partnering with these champions will increase your influence in a particular area and improve your efficiency.

4. Form unit-based safety teams. These partnerships, often referred to as Comprehensive Unit-based Safety Programs(CUSPs),3 improve safety culture in health care by giving front-line providers the tools and resources needed to support improvements that advance clinical safety. CUSP teams utilize unit-based staff members to advocate safety in health care; they will often include your champions and discuss more than infection prevention and control concerns. Ensure that you have a place in unit-based CUSP teams, are providing relevant data to the team, and giving opportunities to engage in performance improvement projects concerning infection prevention.

Lastly, and the most important lesson of the series, is to always listen before you speak. Throughout this series we have been working toward understanding how we can increase our influence and get people to listen to and act upon our words. Perhaps one of the best ways we can accomplish this is through listening first. I started this series with an example from my experience as a mother. Sometimes it is truly a challenge to get my children to listen to me. But do you know what I have discovered? I have found that they are so much more likely to listen to me if I have listened to them first. Sometimes people simply need to be heard, and the health care workers you are working with are no different. They have opinions, perspectives, and experiences that need to be heard and valued. I guarantee you that if you listen to them, they will be more likely to listen to you in return. They will appreciate your communication, you will more easily establish important connections with them, and you will develop lasting partnerships that result in positive change…all because you listened.

Until next time.