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Leading Infection Prevention & Control. Ros Moore CNO Scotland . Will need a pen & paper for abit of audience participation. Together we have come a long way & achieved a great deal . My ambition
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Leading Infection Prevention & Control Ros Moore CNO Scotland
My ambition Infection control and prevention happens without enforced compliance and when no one is watching It is a whole health community issue with pathway solutions It must be embedded in the ‘heart’ of healthcare organisations through structures & governance It must be embedded in the environment and culture of a ward unit or team and in how staff behave and interact with each other and with patients clients and carers Continue to develop the evidence base Be ready for the future
HAI and the Quality Strategy • Quality Strategy ambitions • Person centred • Safe • Effective • Priority area for improvement • integrated programme between SPSP and HAITF to reduce HAI • Must be able to • demonstrate how HAI deliverables will support Quality Strategy ambitions; and • demonstrate how greater integration in delivery of infection prevention and control will be both achieved and sustained.
HAI and the Quality Strategy:context • Greater synergy with SPSP • Revised HAITF Governance construct • Horizon scanning: emerging organisms and AMR • Focus beyond hospital setting • Quality Strategy measure – prevalence of infection • HEAT target development • Spending review
“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning”
Leadership Challenges Adapted from “Nursing Towards 2015 Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015” (Longley, Shaw, Dolan, 2007) NMC Publishing
Its hard & its hard all the time Leadership in this context can feel like “building an advanced aircraft , whilst it is flight, whilst it is being designed & whilst it is being shot at …” General David Patreus 2010
Industrial age medicine Tertiary Professional Care Secondary Primary Information age health care Individual Self care Friends and family Self help networks Professionals as facilitators Professionals as true partners Professionals as authorities
Real change in real organisations is intensely personal and enormously political. ” Nadler 1998 Organisations are microcosm of society as a whole with the same power structures, differentials inequalities Lymbery (2006) described the vast differences in power and culture between various occupational groupings, and the inherently competitive nature of professions jostling for territory in the same areas of
Picture – establish a clear direction and end point Come my people let us kill the SABs Its not enough to talk about SABs targets and patient safety….
Purpose People need the story that gives meaning beyond itself Contact hearts and minds Make it personal Make it visual
Process & infrastructure Make sure the processes at every level are clear & understood & that people understand how the process links clearly to the picture & purpose
Right sort of people in right sort of groups – to avoid problem processing
Part Make people actors not characters – Ensure they can see their unique contribution to the whole Articulate expectations of every person at every level & be consistent Make sure they know other peoples part
Self Audit “We found that successful leaders cultivated a culture of clinical excellence and effectively communicated it to staff; focused on overcoming barriers and dealt directly with resistant staff or process issues that impeded prevention of HAI; inspired their employees; and thought strategically while acting locally, which involved politicking before crucial committee votes, leveraging personal prestige to move initiatives forward, and forming partnerships across disciplines. Hospital epidemiologists and infection perfectionists often played more important leadership roles in their hospital’s patient safety activities than did senior executives.” Reference: Saint SS, Kowalski CP, Banaszak ‐ Holl J, Forman J, Damschroder L and Krein SL. The Importance of Leadership in Preventing Healthcare‐Associated Infection: Results of a Multisite Qualitative Study. Infect Control Hosp Epidemiology. 2010;31:901-907
Know yourself How do you respond to stress ? Try Hard Be Perfect
Using people Ken Thompson 2010 • Mediocre leaders play draughts with their workers – they assume we all move in the same way and are motivated by the same things. • Good leaders play chess – they learn what's unique about each person and the best way to energise us.
Leadership Toolkit this is mine whats yours ? Making groups work TA Herons 6 Targeted interventions Four Ps
RCN 2008 • This nonspecific guidance may at first seem intangible and perhaps even unhelpful. • However, this review has identified a number of ‘risks’ for infection and infection control • problems. None may be sufficient to cause problems and their removal may not be • sufficient to rectify problems. Indeed in some cases (for example high turnover) there may • be no direct remedial action. However, awareness of these risks provides the potential to • prioritise interventions and take preventative actions before harm comes to patients: • • Weak or negative clinical leadership at ward level • • Weak or negative clinical leadership above ward level • • Absence of clear lines of clinical management and responsibility from ward to board • • Excessive ‘span of control’ among clinical leaders • • Unclear roles and responsibilities for infection control • • Lack of clear policies and active support for training • • Absence of an effective multidisciplinary infection control team perceived as exercising • positive leadership at ward or unit level • • High staff turnover • • High use of bank or agency staff • • Low staff morale • • High patient throughput • • Workload not matched to available staffing • • High bed occupancy
“This is how change happens. It is a relay race. Our job is to be part of the race, and then we pass it on, and then someone picks it up, and it keeps going. And that is how it is”
