Hybrid IPs: With Autonomy Comes Responsibility
COVID-19 forced work changes that some want to keep
The infection control team at the University of Kansas (KU) Health System honed their hybrid model to such an extent that there are no plans to go back to the old model with all staff in the central office every day.
They have made this new approach work with high efficiency through computers, laptop cameras, phones, and team meetings and instant message software, all of which have proven a failsafe against feared communication breakdowns.
“Before COVID, we all had individual phones on our desk, and that was changed to be an application on our laptop,” said Maggie Reavis, MPH, BSN, CIC, a KU infection preventionist. “That seems really simple, but it was life-changing to not be tied to a desk phone.”
The infection preventionists are expected to be on site at least three days each week, and they communicate daily with all team members to confirm who is going to be where, Reavis said at a recent webinar held by the Association for Professionals in Infection Control and Epidemiology (APIC).
But it is the more intangible aspects of the new arrangement that have raised job satisfaction. Simple things, such as no commute for a day or meeting your children getting off the school bus, create a better work-life balance through the hybrid program model, she said.
“I was polling the rest of our team about what our content might be for this [presentation],” she said. “Several members said that if we ever considered moving away from our hybrid approach, that they would push back and consider leaving and looking for a different position. They feel like this hybrid approach is so valuable to them, not just as an employee or an infection preventionist, but as a human being. It’s brought a lot of job satisfaction and life satisfaction amongst our team.”
Necessity the Mother of Invention
Lance Williamson, MSN, RN, CIC, infection prevention supervisor of the KU team, also spoke at the APIC webinar, describing some of the roles in a group that includes about a dozen members.
These include infection preventionists across an array of designated areas, including high-level disinfection and sterilization, a clinical data specialist, ambulatory care, personal protective equipment (PPE), and six infection preventionists dedicated to all inpatient locations and units.
This program obviously is strongly staffed and, looking back to pre-pandemic days, Williamson said the team office was a little crowded. But all that changed when the first U.S. cases of SARS-CoV-2 began to increase rapidly in 2020. The hybrid model was invented because it became a necessity.
“We had lots of collaboration before the pandemic, and that was because we were all in the same room together most of the time, he said. “Looking back, I think we benefit now from being a little more spread out, because our office would be very busy. It would get loud sometimes when we had a lot of conversations going on.”
As the pandemic hit, the team necessarily had to operate with more individual autonomy as the hybrid system was developed and refined. Describing himself as a macro-manager, Williamson said he was comfortable giving infection preventionists autonomy as it became clear this was going to be necessary to keep the program viable.
“Collaboration suffered during this time because we were just kind of doing the very best we could with the information we had,” he said. “There were so many changes coming at us. We rarely had times that we could get together and collaborate, and we were all thrust into working solo for a while.”
The virtual communication and collaboration that came out of this is reflected in the program today.
“Now, I think we’ve got the best of both worlds, but I’m continuing to evaluate where we can do better,” he said. “But I think we’re at a really great point where we’ve taken the things that we’ve learned from what we did prior to the pandemic and what we did at the height of the pandemic, and now we have a much more balanced approach. Autonomy is now promoted with accountability.”
There are various virtual and real touchpoints that keep this accountability in focus, and the infection preventionists have demonstrated that they can be trusted taking responsibility for getting their work done.
Collaboration is subject to ongoing improvement, and certain important meetings are held on site for the whole group.
“The hybrid work culture is driven by three priorities: communicate, be available, and do your job,” Williamson said. “Those are the expectations for my team and for myself.”
Many routine desk tasks can be done in a home office, while hospital time is the opportunity to circulate and communicate with staff and patients.
“I do not want my team to come in and sit at their office computer all day,” he said. “We have so many things that we need to do when we are at the hospital. That includes rounding, taking questions on the units, talking to staff in person, and doing observations.”
Accountability for your staff is determined by leadership style, he adds. Of course, it is all hands on deck if some emergency arises, and the team is well aware of that. “It is not whether or not your staff are in person, or you can observe your staff and what they’re doing,” Williamson said. “This is something I learned early on. You give that responsibility to your staff and they understand the expectations that you have set.”
Reavis does rounding and face-to-face communication when in the office, and often crunches hospital infections, epidemiology data, and antibiotic stewardship documentation when working in her home office.
“Our rounds include the usual stuff — Joint Commission preparedness, hand hygiene, PPE, and isolation compliance,” she said.
The team shares and rotates responsibilities for staff education for new employee orientation and educational updates as needed.
“You have to have the infrastructure set up to be able to be successful with this type of environment,” Reavis said. “We have docking stations set up at each of our desks and with cameras on our laptops. As we plan our week, I evaluate the days that are really meeting-heavy vs. days that are open with time for rounding.”
Hybrid benefits include the fact that everybody is set up to work at home if something comes up on their designated office days.
“You can still work from home whenever you’re mildly ill, which I think is huge for our field, because we set an example of not coming to work if you’re sick,” she said. “This system allows us to work from home if we have a cough or if a kid is sick.”
With autonomy comes responsibility, and the team errs on the side of overcommunicating to make sure they are all on the same page.
“We have a better approach now, running our own calendar and making sure that we’re looking at our priority list, our to-do list, and blocking out time on our calendars to make sure that we’re making time for the things that we really need to do,” said Reavis.
The team has a daily morning text chat that includes all infection preventionists, the supervisor, and the administrative assistant. In addition to confirming who is working where, the chat is useful to seek consensus on an issue.
“If there’s a question about something that we’re looking at, or you just want to ask a question for the whole team, you can put it on that chat and you’ll pretty quickly get everybody’s responses, which is great,” she said.
In addition, the infection preventionists hold 15- to 30-minute virtual huddles three times a week to review issues and coordinate.
The hybrid program also allows screen sharing, which is beneficial if you want to show someone exactly what you are looking at. “Being able to share my screen and point to it in real time is extremely helpful,” Reavis said.
Some challenges to this approach are social isolation, and not having the easy banter that comes with in-person exchanges. The team has tried to address this by including games and sharing personal items, such as baby photos.
For virtual meetings, being on camera is encouraged but not required. “It does contribute to more engagement during a virtual meeting,” she said.
In addition, those who are not comfortable doing presentations in front of large groups can hone their skills by doing virtual presentations from their home office.
“It allows people to be comfortable and in their own home setting and able to communicate and share information with a little less anxiety about the presentation,” Reavis said. “Building your ability and skills to communicate in this way is a really unique opportunity.”
Since the hybrid approach is not as “natural” as the time-honored office setting, it has be engaged with “intentionality” by all members of the team.
“Intentionality is important to maintain those relationships, especially with our more specialized roles on our team who aren’t on site with the rest of us often,” she said. “They really have to engage with the rest of us on purpose, in order to stay in the loop and feel like they’re a part of the group.”
For better or worse, infection control and prevention programs had to reinvent themselves as COVID-19 hit the healthcare system in 2020. Some hospitals went to “hybrid” programs, with staff working both inhouse and from home on a rotating basis.
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