Why QI plus IP is more than alphabet soup
Working closely is more important than ever
It seems impossible when she recalls it, but Kathleen Kohut, MSN, CIC, CNOR, director of infection prevention at Cone Health System in Winston-Salem, NC, tells a story of an infection prevention department that was left out of the discussion of meeting infection prevention standards for an upcoming Joint Commission survey. The hospital administrator figured the quality department, which handled survey matters, could handle all survey matters, regardless of which department the particular standards related to.
It is the kind of separate-silo thinking that has kept infection prevention departments and quality improvement departments from working together in many organizations. But in a time when reducing hospital-acquired infections has taken on an important role in terms of reimbursement and public awareness, that time is over, and she says if you don’t have a working relationship with each other, the time to forge one is now.
Understanding each other’s jobs
Start by understanding each other’s job, she says. There’s a lot over overlap and intersect. Identify the commonalities. Pair up your quality and infection prevention staff, or just limit it to managers. Schedule a couple of lunch dates. On the first, bring your job descriptions. Look for the commonalities and differences.
Over the second lunch, go over the Joint Commission infection prevention standards and the required infection control plan. Discuss where you see problems and opportunities for improvement, she says. Where do you have questions and need help? What expertise does your counterpart department have that you could use? Where do they need your help?
Once you have gotten to know each other, follow each other around for a couple of hours, Kohut suggests. IP is "a piece of the quality puzzle," so being familiar with that department’s world can only assist you. And knowing what you do can help the infection control department know who to reach out to when they have a problem that is beyond their grasp.
While most people in healthcare know that their world is all about change, Kohut says you might run into some people who are less than flexible and who don’t want to share information or resources. For those individuals, your best bet is to come at them with data and a program to articulate. Show them why it is in their interest, how you can help them and bring value to what they do. Be respectful of their time and be efficient, she says.
If quality and infection prevention aren’t joined at the hip yet, they will be soon, says Kelley Boston, MPH, CIC, a member of the communications committee of the Association of Professionals in Infection Control and Epidemiology (APIC) and a regional manager at the Houston-based consultancy Infection Control and Management Associates.
"The two departments have the same goals: patient safety, safe effective patient care, and cost containment," Boston says. "We do have slightly different ways of looking at things, though — a broad view in quality improvement, and a narrow view in infection control." For example, QI wants to improve things in general throughout the hospital to reduce the chance of hospital-acquired infections. Infection control, however, wants to find a way to mitigate infection when it occurs or prevent it in specific circumstances.
Boston says when you meet up with your counterparts, be clear about your agenda and priorities. "If you have specific things you are working on and want to achieve, be transparent. Be clear about what you need from the other person and what they can do for you. Infection control has a wealth of knowledge and skill on the science side that you might not have."
And what can you provide in return? Implementation skills. "We can partner together and really make an impact on patient care by using each other’s strengths," says Boston.
Like Kohut, Boston thinks you and your infection prevention counterpart should spend time in each other’s departments. "It is not a bad thing to walk in each other’s shoes," she says. "You will see us in the future looking for more quality skills. We want, and need, to develop them. That would be an opportunity for us to do so."
Quality is also good at facilitating discussions between departments to help create a good improvement project, says Boston. That is another skill that many infection department managers lack and could use some tutelage in. They might swap it for some training in technology that you don’t have, or introductions to front-line staff, with whom most infection prevention professionals have a great working relationship.
If you need a last good reason to make nice with your infection prevention coworkers, consider these two examples from Boston’s past. "One organization I worked with had a direct reporting relationship between infection prevention and the quality director," she says. The director was constantly pulling the infection staff off the floor to essentially count infections, rather than using them to make meaningful changes. When the infection prevention staff brought this up to the quality director, they were brushed off. The staff became so demoralized they left as a whole, with all their knowledge and expertise.
Compare that to another organization Boston worked with. Initially, there were some lingering communications problems between the two departments. But they instituted a weekly meeting at which they discussed areas where the two departments could work together or merely support each other. They started to partner on projects, and eventually, their collaboration inspired others to likewise work outside their silos.
"The work you each do matters to all of you equally now," says Boston. "The goal is the same, right? It is the patients."
For more information on this topic, contact:
• Kathleen Lutton Kohut, RN, MSN, CIC, CNOR, Director of Infection Prevention,
Cone Health System, Winston-Salem, NC. Email: email@example.com.
• Kelley Boston, MPH, CIC, Regional Director, Infection Prevention & Management Associates, San Antonio, TX. Telephone: (713) 721-0813.