Achieving buy-in: the key to success

Opening this year’s Infection Prevention conference and exhibition, IPS president Julie Storr emphasised that infection prevention and control is about saving lives – a key element in achieving this will be the use of patient safety and implementation science, which can help delegates translate evidence into practice and deliver service improvement. Influencing behaviour of healthcare workers, in order to improve patient safety, was the core theme of the morning sessions and Julie Storr reminded delegates of the ‘huge sphere of influence’ that delegates have collectively. “There are thousands of hospitals and healthcare facilities, and over 1.7 million health and social care workers in the UK and Ireland that we can potentially influence, in our day-to-day jobs. Most important is the fact that, through our abilities to influence others and change behaviour, we can have an effect on the lives of patients and service users. The vision to ensure that no patient is harmed by preventable infection is all about the people that receive health and social care. We can stop them from being harmed and, in some cases, from dying.” At the conference, IPS officially announced the appointment of two new patrons: Professor Didier Pittet and Professor Tricia Hart. Prof. Pittet is the director of the infection control programme, University of Geneva Hospitals and Faculty of Medicine, and the external programme lead for the WHO First Global Patient Safety Challenge: Clean Care is Safer Care. In 2007, he was awarded an honorary CBE for services to the prevention of healthcare-associated infections. Prof. Tricia Hart was appointed chief executive of South Tees Hospitals NHS Foundation Trust in January, this year. A previous nurse, midwife, community nurse and health visitor, Tricia Hart has been a member of the Caldicott committee and nurse advisor to Robert Francis on the inquiry into the failings at Mid Staffordshire. She was awarded the national award for inspirational leadership in 2009 and was recently named as one of the HSJ’s top 100 clinical leaders in the NHS. Speaking at the conference opening, Prof. Hart said: “The work that many of you do, not only across the UK, but also internationally, is some of the best when we look at the outcomes in terms of harm reduction, continued improvement and sustainability in patient safety – whether this is in the hospital or community setting. “This event is about reflecting on our potential, our behaviour change and our opportunity for leadership, when we see issues that could impact on the safety and care of patients. It is important that each of us speaks up and speaks out when we see care that could be compromised – particularly as the NHS is going through such major financial challenges. We must ensure that we do what Robert Francis said – to put people before numbers.”

Securing organisational buy-in

Prof. Dale Fisher, senior consultant and head of infectious diseases, National University Hospital, Singapore, went on to give a presentation on ‘gaining organisational buy-in to infection prevention’, describing how sustainable buy-in can be achieved through a mixture of methods – including the draconian, innovative, inclusive, empowering and fun. Prof. Fisher pointed out that achieving buy-in is “possible and potentially very straight forward”, but those working in the field of infection control would ideally like to see this from the start and without controversy. “In a disaster or emergency situation, there is no problem – buy-in is automatic,” commented Prof. Fisher. “During an outbreak of SARS in 2003, we had no problems with limiting visitors, registering people when they came to the hospital or people wearing their personal protection equipment (PPE).” He went on to explain that there were PPE stations at every door, the administrators got involved, and there were briefings on updated hospital infection control policies twice a day. “We had no difficulties in getting people to understand infection control policy. So what is it about this emergency scenario that makes it easy – while, with less acute problems, it is more difficult?” said Prof. Fisher. He explained that there are multiple factors: the clinical viewpoint may be poorly expressed or unappreciated, and it can prove difficult to obtain an alignment between the hospital administration, health ministry, politicians and the public. The challenge lies in ensuring ‘buy-in’ among all of these stakeholders – at the same time. The World Health Organization (WHO) states that complete buy-in is needed for successful infection prevention – it is important to create a culture of attention to patient and healthcare worker safety throughout the institution, which includes administrator buy-in. He cited a study by Kirkland et al (2012) examining the impact of a hospital-wide hand hygiene initiative on healthcare-associated infections. Key interventions included: