My mother Mary, a little Italian woman as tall as she is wide, always used to tell me how she hated hospitals because they just made people sicker. Imagine her reaction when I told her that I was going into healthcare.
Media reports about rampant infections in hospitals only fed her fears. Then, I was hit with a one-two punch: In 2011, my team clued me into our high rate of healthcare-associated infections, and, in 2012, the media reported that my hospital — Olympia Medical Center in Los Angeles — had one of the highest rates of central-line associated blood stream infection in the nation. We had a CLABSI rate of 4.67 per 1,000 central venous catheter-days, which was about four times higher than the national rate. Was I running the type of hospital my mother always feared?
The news was a bolt out of the blue because my previous team, up until December 2010, wasn't giving me accurate data about our infection problems. I knew that something dramatic had to be done. I couldn't stomach the thought of harming patients, not to mention rousing the ire of my Sicilian mother.
Target zero
To enact meaningful change, I needed to understand what was being done, and what was not, to prevent and control the spread of infection in my hospital. I asked the directors of infectious disease, quality and nursing to develop both an assessment to measure infection and a plan to combat our unacceptable rate of CLABSI and other infections.
Over the course of a near-sleepless month, I worked very closely with the medical executive committee and the infection preventionists to come up with a path forward that would reverse this problem.
To start with, the heads of quality, nursing and infection control visited every patient twice daily, giving me daily reports on their current condition, with a focus on any possible or confirmed infections. To this day, I get a report every Friday with this summary. If we see that a unit is slipping or a certain cohort of patients is regressing, we hold court and identify a solution to the problem.
On top of this comprehensive patient monitoring program, we launched a robust hand hygiene campaign to identify those who were not complying. Everyone was held accountable.
Campaign tactics included buttons and posters that encouraged patients to "Ask If I've Washed My Hands." We had "secret shoppers" deployed throughout the hospital to report on doctors and others who were reluctant hand washers.
Initially, I heard a lot of excuses. But, there was no compromise, no matter how busy they were, or what station in life they had attained. Infection control was and is an organizational priority, and I was willing to do whatever was necessary to improve the quality of healthcare we were providing. My job was to convince hospital staff that preventing potentially deadly infections was the right thing to do.
Lessons learned
The road to success was by no means easy, but we learned a lot along the way:
1. Don't expect — inspect. Sometimes you can't take what's being fed to you at face value. If you dig beneath the surface, you might find some things that need to be changed.
2. The buck stops with the CEO. In order to make infection prevention an organizational priority, the boss has to be the driver. Leaders need to be visible to staff, showing hands-on commitment, talking the talk and walking the walk. Besides just talking about the process in order to be the role model, I was the first to receive the flu shot, kicking off the hospital flu shot campaign.
3. Transparency can be frightening, but it should also be embraced. Organizations are forced to look at themselves and create benchmarks. Transparency can bring about necessary change.
4. Having a targeted mission can build a sense of community. Bringing all parties — healthcare personnel, medical staff, patients and administration — together to achieve a common goal can encourage community building.
5. Educate the staff; do not hide the problem. Once the problems are exposed, staff members are better able to internalize, own and correct the situation.
6. Recognition is critical to success. To keep them motivated, it is important that leaders, physicians and hospital staff are credited for the work they have performed.
7. When the goal is met, don't stop. Continue to provide incremental goals. Provide ongoing education and continue to celebrate your success.
8. Improvement in one area can cause waves of improvement in other areas. Making it your mission to improve one quality area can improve other quality areas, such as reducing readmissions. In our case, when we reduced infections, our patient satisfaction scores improved dramatically.
Success can be achieved
We hit our goal of zero HAIs in six months. Today we are nearly running at zero for all targeted infections, including CLABSI and methicillin-resistant Staphylococcus aureus. That means we've had no CLABSIs in the past four months and no cases of MRSA since January 2013. With my team's help, we were able to make infection prevention a part of the DNA of Olympia Medical Center.
Now I know that my mother would be safe in my hospital. Can you say the same about yours?
John Calderone, PhD, CEO at Olympia Medical Center in Los Angeles, Ca., received the 2013 Healthcare Administrator Award from the Association for Professionals in Infection Control and Epidemiology.
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