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ISQua Fellowship Forum

Excellence in Leadership and Management Making a Difference in Reducing Infection Rates

Phil Hassen, President of the Canadian Network for International Surgery; ISQua Fellowship Forum Moderator.


August 2016

Through excellence in leadership and management and commitment to using current clinical evidence, hospitals and health care organizations can make a difference, in reducing infection rates. To be successful, health care leaders and managers need to develop key leadership competencies necessary to influence and make quality and safety improvements. Furthermore, it is vital to learn from others who have demonstrated results and adopted best practices in reducing infections.

It has been reported that every year, in the United States’ hospitals, as many as “100,000 people die of health care associated infections (HAI)”. (Sanjay Sant, et al, Infection Control and Hospital Epidemiology, 2010). Similarly in Canada, it is estimated that with one-tenth the population it experiences a similar proportion of deaths. An unrelenting focus on the goal of reducing and eliminating infections acquired by patients in hospitals and other health care settings will lower costs to the system, and more importantly morbidly and mortality rates.

The literature shows that some hospitals and health care organizations do much better than others in reducing infection rates, and in these cases leadership contributed to making the difference. For this reason, let us consider four competencies of leaders who have been successful in hospitals and other healthcare organizations in reducing infections. This includes:
1. Spend time and effort to achieve a culture of excellence
2. Are "Strategic Thinkers"
3. Focus on overcoming challenges as well as enabling others to solve problems and
4. Inspire others and develop leadership skills in others

1. Successful leaders spend time and effort to achieve a culture of excellence
Successful leaders understand their organizations’ culture and develop effective, clinically excellent, evidence-based practices and procedures for delivering care and services. Medical and nursing leaders understand and communicate the mission, vision and values and enlist staff in building a positive organizational culture. Changing an organizational culture to be more patient focused and aligned with excellence in patient care including the use of evidence and the best infection control practices takes time and will produce invaluable results for patients as well as build staff pride. In my own experiences, making a positive cultural change took at least 3-5 years (depending on your starting point). Also, I observed most caregivers I worked with, are highly motivated to do their best to create a culture of excellence.

2. Successful leaders are “Strategic Thinkers”
Hospitals and health care settings successful in reducing infections have leaders who consistently maintain their focus on patient care, plan ahead and look at the long view instead of getting lost in tasks and the details of day to day operations. Their efforts are to build strong positive relationships enabling staff to work across disciplines to solve infection control problems. Leaders translate strategy into action. For example, in one Canadian hospital where I worked leaders and staff identified causes associated with surgical infections, set bold goals for improvement, implemented protocols to be used for all surgical patients, collected and analyzed data and communicated results. They started with an average surgical infection rate of approximately 5%. The medical and nursing leaders with a team including surgical staff and others were successful in reducing the rate under 2%.

3. Successful leaders focus on overcoming challenges as well as enabling others to solve problems, and in this case reducing infections
Excellence in leadership includes using strong problem-solving skills and most importantly enabling others to solve problems. Leaders who interact with staff in ways that assist them to be positive and confident about their abilities to solve infection control problems are much better received by staff and have demonstrated in hospitals to successfully lower infection rates. Furthermore, teams working across the hospital or health care setting, sharing best practices and staying well informed about health care-associated infection rates are usually better equipped to prevent and reduce them.

Successful leaders focus on solving priority infection control challenges including the following:
• Hand-hygiene
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Clostridium difficile
• Unnecessary use of antibiotics
• Making infection control a priority for environmental services including housekeeping
• Vaccinating staff
• Reporting all infections
• Working with other organizations (hospitals and community organizations) and
• Getting the senior team focused on infection control as a priority

4. Inspire others and develop leadership skills in others
Influencing others to focus on infection control challenges includes developing leadership skills in others and providing them with opportunities to acquire knowledge, skills, tools and methods to reduce infections. Rather than a more traditional military model of “command and control” leaders inspire others, encourage collaboration and creativity and invest in their learning and development. Strong leadership support is necessary to enact evidence based infection control protocols and further to ensure written policies and procedures do not limit staff’s abilities to create solutions, but rather enables them.

Moreover leaders walking around and visiting patient care units for which they are responsible, looking for good infection control practices, and explicitly reinforcing these makes a difference. Generally positive teaching and coaching staff on excellent infection control practices by leaders in their patient care areas is well received.

According to Accreditation Canada, hand hygiene is considered the single most important way to reduce health care-associated infections, yet compliance with accepted hand-hygiene practices is sometimes poor. Leaders make a difference by role modeling cleanliness generally, providing education in hand hygiene and measuring the use of effective hand hygiene practices. For example, the World Health Organization's (WHO)

“Five Moments for Hand Hygiene” are listed below. (Visit the World Health Organization internet site for more information on WHO Guidelines on Hand Hygiene in Health Care and for other infection control ideas you can implement.)

Your 5 Moments for Hand Hygiene
World Health Organization

1 Before Touching a Patient
2 Before Clean/Aseptic
3 After Body Fluid Exposure Risk
4 After Touching a Patient
5 After Touching Patient Surroundings

In closing, and as you consider these ideas think about the competencies and how leaders makes a difference in reducing infection rates. There is no question health care leaders and managers play an important role enabling a patient safety culture, which is enabling in reducing the risk to patients of acquiring infections. 

In summary, leaders make a BIG difference in reducing infections in health care organizations. You as a leader or leader-in-waiting can develop the key competencies described in this Forum and learn from others who have been successful in reducing infections.

Discussion Questions
1. What are some of the major infection control challenges facing your organization?
2. Do you currently report, measure and evaluate various types of infections and their rates in your hospital/health care organization? If so, provide a summary. If not, explain.
3. What are some initiatives you and staff are involved in related to the goal of preventing or reducing infection rates?
4. What leadership competencies described in this Forum are your strongest? What is one area needing improvement?
5. Does this Forum in any way, make you rethink ways you can improve infection rates? If so, in what way? What goals do you have to improve infection rates?

• Sanjay Saint, MD, MPH; Christine P. Kowalski, MPH; Jane Banaszak-Holl, PhD; Jane Forman, ScD, MHS; Laura Damschroder, MS, MPH; Sarah L. Krein, PhD, RN. Infection Control and Hospital Epidemiology, September 2010, vol. 31, no. 9
• “The Importance of Leadership in Preventing Healthcare-Associated Infection: Results of a Multisite Qualitative Study” Top 10 Infection Control Challenges. Association of Professionals in Infection Control and Epidemiology, (APIC)
• World Health Organization (2009). WHO Guidelines on Hand Hygiene in Health Care. World Health Organization. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
• Accreditation Canada. Required Organizational Practices Handbook. 2016


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