Rebekah Moehring, MD, MPH, shared strategies for building internal capacity to meet infection prevention goals in resource-limited settings at the SHEA Spring 2017 Conference on March 29, 2017.
Infection prevention is complicated enough, but in resource-limited settings it can pose an even greater challenge. On March 29, 2017, at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference in St. Louis, Missouri, Rebekah Moehring, MD, MPH, assistant professor, Duke Infection Control Outreach Network (DICON), Duke University Medical Center, shared strategies for building internal capacity to work together to tackle common goals through a collaborative effort between the quality, antimicrobial stewardship, and infection prevention departments.
“I think that when we think about these three different programs in our hospitals, often we think of them as separate entities, but in the resource-limited setting there is actually much more overlap and the reason is that there’s just a limited number of personnel to perform these roles,” Dr. Moehring states. “So, being able to overlap in terms of our efforts, really serves all three programs very well, if we can come together and have a similar initiatives and goals to go after together. How can we do this?”
First, Dr. Moehring discussed the concept of the “small n” in resource-limited settings, which referred to the fact that there is a smaller number of staff to perform tasks that need to get done and adequately implement initiatives. Where in some instances this can be a drawback, in other instances this can also work in the favor of the facility. With less staff, developing personal relationships with colleagues is easier, and these relationships “are the key to success.” Dr. Moehring added, “I think in resource-limited settings it’s especially important because it’s the same people you’re working with for more than one task that needs to get done.”
When it comes to building internal capacity to meet these goals, first find common ground among personnel working in all three departments (quality, infection prevention, and antimicrobial stewardship). Where do they overlap? According to Dr. Moehring, all of these programs strive for: providing safe and effective care, improving patient experience, improving the reputation of the institution, working towards improving the utilization of resources, and meeting regulatory needs “that keep [the] doors open and keep [the] service to patients going,” she said.
Dr. Moehring continued to provide tips on “the best way to deliver a message,” to accomplish goals across departments. The best way to do this is to be specific when appealing for help. “I think just recognizing that you’re coming from different perspectives, understanding that it’s a shared problem that we all work on, and then giving something very specific [that we need] to attack together” is important, according to Dr. Moehring. To do this, you need to “play to their strengths” and “speak their language.”
For example, when addressing the quality department in your facility, you need to understand their strengths, which consist of “a lot of access to data, or understanding how to get access to data, they also have a lot of ability to influence other groups across the hospital and leadership. They have a lot of influence on what gets put on score cards and the metrics that get put in front of leadership and the interpretation of those metrics as well.”
Next, Dr. Moehring suggests focusing on using language that appeals to them. She said, “using the language around metrics, outcomes, processes, score cards, run charts, all of those types of language really will help and gets them excited, because that’s what they’re trained to do: look at data, interpret that, and show change.”
One of the biggest strengths when it comes to antimicrobial stewardship personnel lies in their clinical knowledge and dedication to patient care. “I think that in many times these individuals are strong educators, they have a good relationship with frontline clinicians, [and] so if you could somehow use that relationship and use them as a proxy for infection prevention, getting infection prevention’s messages through to frontline clinicians, I think that can also be a good way to use their influence as a partner,” she added. In addition, antimicrobial stewardship personnel tend to be more adaptive and flexible, since most antimicrobial stewardship programs are in their infancy. What language should you use when speaking to a steward? According to Dr. Moehring, “Key words when you’re appealing to a steward would be trying to support clinical decisions for direct patient care, which is what they really, really care about—managing infections and improving patient care. Certainly, if you can tie what you’re doing to optimizing antibiotic use, that would get their attention and anything that really supports the pharmacy I think goes a long way when you’re messaging for stewardship.”
The next step in developing strategies to build internal capacity is to be familiar with and utilize existing resources. “This actually takes some work because it’s constantly changing. I think in general we do an annual assessment to see how our program’s doing, but there may be a lot that’s changing in the interim between those assessments as well,” Dr. Moehring said.
“Understanding what assets you have and what the limitations are of your program is important, and knowing when to ask for support and helping leadership prioritize those ‘asks’ [is important] as well.” She reminded everyone that “tweaking” or “updating” a current resource is much easier than completely re-doing it and some resources that one department may be using could be revised or updated to also be beneficial in other disciplines as well. For example, “there may be a lot of good things going on in the non-infection prevention area that we would be able to tap into and then apply it to infection prevention goals,” she said.
The last step that Dr. Moehring wanted to drive home was the importance of sharing the credit for work done to reach a common goal. “Giving credit where it’s due at leadership meetings [and] building other people up goes both ways, [and] so it’s important to keep those messages positive, even if you had to work through some major conflicts in the process. Getting there at the end and giving your appreciation really goes a long way,” she said.
Dr. Moehring concluded her presentation by providing a couple of examples of how personnel from all three departments worked together to reach a common goal in different facilities. One example she provided was how a DICON-affiliated hospital dealt with changes made by The Joint Commission to standards pertaining to employee education on antibiotic stewardship and catheter-associated urinary tract infections (CAUTI). To tackle this, infection preventionists took the first step and updated the infection prevention and CAUTI content in an existing personnel education module and passed it on to the stewards who then added their stewardship content and worked with the information technology team to get the information loaded into the system. The quality personnel took it from there by providing staff with a deadline to get it done, tackling compliance, and pulling the data to have it ready for the survey.
“I think that sometimes a ‘small n’ is actually a good thing, and having those relationships and being able to build that up in reaching your goals actually makes it easier,” concluded Dr. Moehring, “Certainly, those personal relationships are key to making it work in smaller settings.” She added, “Play to each other’s strengths and what you like to do and really focus the message when you are influencing or recruiting from other departments. Finally, promote other programs as well as infection prevention and that will keep the cycle going for the next challenge.”
Grants: CDC, Agency for Healthcare Research and Quality
Royalties: UpToDate, Inc.
Honoraria: Society for Healthcare Epidemiology of America
SHEA Spring 2017 Conference
Building Internal Capacity