Aiming for Zero Tolerance: Are You Ready to Be a Change Agent?

Kathleen Meehan Arias, MS, CICArias Infection Control Consulting, LLCCrownsville, MD

APIC Greater Cincinnati-Dayton Fall Symposium October 1, 2008

What does zero refer to?

Zero tolerance? Zero infections?

Eliminate all HAIs? Eliminate specific HAIs?

A marketing campaign?

We’re headed for Dodge City…

Change Agent

Google: 748,000 hits for “change agent” in 0.05 seconds

Encarta: “Somebody or something that brings about, or helps to bring about, change”

Wikipedia: lacks “change agent” page, but….

http://encarta.msn.com/dictionary

“I know that you're afraid. You're afraid of us. You're afraid of change. I don't know the future. I didn't come here to tell you how this is going to end. I came here to tell you how it's going to begin… I'm going … to show you… A world where anything is possible.

Where we go from there is a choice I leave to you.”

--Neo, The Matrix

The IP as Change Agent

A person that effectively redirects the capacities of individuals or organizations to implement change

--Arias

Do we need change?

HAIs: Worldwide Problem Health care-associated infections

(HAIs) are a global problem Affect patients, their families, and

healthcare system At any time, HAIs affect over 1.4

million people worldwide

Tikhomirov E. WHO Programme for the Control of Hospital Infections. Chemiotherapia 1987;3:148–151

Burden of HAIs--U.S.,2002

1.7 million infections in hospitals 1.3 million outside of ICUs 4.5 per 100 admissions

99,000 deaths associated with HAIs 36,000 pneumonia 31,000 bloodstream infections (BSI)

Klevens et al. Pub Health Rep 2007;122:160-6

That amounts to one HAI-related death every 5.3 minutes!

Culture

The collection of values, beliefs and assumptions that guides behaviors1

An organization’s pattern of response to problems and opportunities2

1. Pronovost. Qual Saf Health Care 2003;12:405-10

2. Westrum. Qual Saf Health Care 2004;13(Suppl II):ii22-ii27

Beliefs and assumptions guide behaviors

Belief and Assumption

One-third HAIs are preventable Most HAIs are inevitable outcome

of complex health care and sicker patients

Haley RW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121:182-205.

Recent Findings

Higher proportion of HAIs can be prevented ventilator-associated pneumonia central line-related bloodstream

infections In 2002, 99,000 deaths related to HAIs:

36,000 pneumonia and 31,000 BSIs

Harbarth S, Sax H, Gastmeier P. J Hosp Infect. 2003:54:258–266

“The past is over.”G.W. Bush

We Can Do Better Many hospitals, professional

associations, and organizations have implemented major initiatives to promote HAI prevention

Hospitals that have committed to infection prevention have made it happen

Many Success Stories Individual hospitals-U.S.1:

Allegheny General Hospital (Pittsburgh, PA) - CLA-BSI in neonates

Hospital of St. Raphael (New Haven, CT) - CAUTI

Pittsburgh Regional Health Initiative

Richards C et al. Emerg Infect Dis; Mar-Apr 2001

Many Success Stories Individual hospitals – Netherlands1:

5 hospitals reduced SSI rates Institute for Healthcare Improvement Your organization?

Geubbels E et al. Am J Infect Control; 2004;32:424-30.

Relax--Change is Good

Essential Elements for Change

Evidenced-based practices Measurement and feedback of

information Collaboration between all levels Leadership support Continuous learning and reflection Everyone held accountable

Guiding Principles for Change Agent

Go where the energy is Get the right people to the table Build on the organization’s history

and collective intelligence

Baird-Wilkerson S. A monograph on creating organizational

change using a living-systems approach. 2003

Guiding Principles for Change Agent

Understand the processes that produce the result

Share information Move from silos to collaboration

Baird-Wilkerson S. A monograph on creating organizational

change using a living-systems approach. 2003

Roles of the Change Agent Reflector Provocateur Confronter Space keeper

Baird-Wilkerson S. A monograph on creating organizational

change using a living-systems approach. 2003

The Reflector Assists organization to engage in

self-reflection Self-reflection of change agent Self-reflection of group

The Reflector: Self-Reflection

Understanding of what is happening depends on change agent’s capacity for reflection and learning

Shaped by professional and personal experiences

Must have self-awareness of impact on others impact that others have on self

Let’s shoot the messenger!

Hostile feelings toward those who introduce change

View this as normal human behavior

Change agent must: Respond reflectively, openly, and

honestly rather than defensively, judgmentally, or personally

The Reflector: Group Reflection

Help individuals see who they are Based on what they do — not who

they say they are or what they say they do

Help separate perception from reality

Change agent must be: Active listener Non-judgmental

The Provocateur

Raises issues to incite a response The provocateur is:

A person who provokes trouble, causes dissension, or the like; agitator1

A person hired to make trouble2 One who provokes3

1. Dictionary.com; 2. Online Etymology Dictionary; 3. Merriam-Webster

The Provocateur

Measurement drives performance Show me the data!

Get people engaged: Who are they in relation to the data?

How do they have the ability to change the data/results?

Sometimes it’s not so easy…..

Show Me the Data….Central line-associated BSI in ICU, by quarter, Jan. 2005 - Dec. 2007

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4.0

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The Confronter

Unveils what others refuse to see The confronter is:

One who confronts Confront:

to challenge; to cause to meet or bring face-to-face (Wiktionary);

to bring together for examination or comparison (Dictionary.com)

The Confronter

Unveils what others refuse to see

Have you asked people how often they practice hand hygiene?

The Confronter Unveils what others refuse to see

Have you asked people how often they practice hand hygiene?

Have you measured how often they practice hand hygiene?

ASM survey, 2007

What they say: 92% adults say

they always wash hands after using public restrooms

What they do: 77% observed

doing so

www.asm.org

The Space Keeper Supports an environment that

promotes honest dialogue

The Space Keeper Set the stage: physical and mental Don’t let people escape! Foster creativity: ask question

rather than suggest answers

The Space Keeper

Deliberately encourage discontent with the status quo

Create conditions in which every person can design systems and processes that produce outcomes that may seem unimaginable

Skills Needed Communication Leadership Ability to see the big picture Interpersonal

Listening, negotiation, relationship building, conflict management

Motivational

Assume the Role Challenge status quo Frame a specific compelling vision

Articulate vision so others can embrace it

Listen, listen, listen use ears and eyes: read faces and body

language to understand what people are not saying in words but may be expressing or suppressing

Assume the Role

Identify the right talent & build teams with needed skills Leadership, interpersonal relationship,

communication, knowledge of the organization and the processes

Lead the way

Assume the Role

Focus on Goals rather than roles Collaboration rather than competition Ideas rather than personalities Achieving the desired outcome

How do you know if you are successful?

How do you know if you are successful?

Better patient outcomes Lower HAI rates Reduced transmission of infectious

agents Increased compliance New language adopted by others

Infection control becomes infection prevention

What did she say? HAIs are worldwide problem HAIs are not an inevitable

outcome Change is needed to eliminate

HAIs Change agents play many roles The IP is in an ideal position to

serve as a Change Agent

Final Note

If you think you're too small to be effective, you’ve never been in bed with a mosquito.