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					Leading Infection Prevention
         & Control
         Ros Moore
        CNO Scotland
 Will need a pen & paper for
abit of audience participation
 Together we have come a
long way & achieved a great
                                 NHS Scotland SAB HEAT Progress
                                  (Quarterly rolling year against number of cases)





1500                                                                                                30% Target

                                                                                                    Further 15%


       Apr 2005 -   Apr 2006 -       Apr 2007 -        Apr 2008 -       30% TARGET    15% TARGET
       Mar 2006     Mar 2007          Mar 2008          Mar 2009         Apr 2009 -    Apr 2010 -
                                                                          Mar 2010      Mar 2011
                        NHS Scotland MRSA Bacteraemia Quarterly Results
                                                       (Quarterly number of cases)







 Apr 05 - Jun 05   Jan 06 - Mar 06   Oct 06 - Dec 06       Jul 07 - Sep 07   Apr 08 - Jun 08   Jan 09 - Mar 09   Oct 09 - Dec 09
                       NHS Scotland MSSA Bacteraemia Quarterly Results
                                                       (Quarterly number of cases)







 Apr 05 - Jun 05   Jan 06 - Mar 06   Oct 06 - Dec 06       Jul 07 - Sep 07   Apr 08 - Jun 08   Jan 09 - Mar 09   Oct 09 - Dec 09
              My ambition
 Infection control and prevention happens without enforced
          compliance and when no one is watching

 It is a whole health community issue with pathway solutions

      It must be embedded in the „heart‟ of healthcare
       organisations through structures & governance

It must be embedded in the environment and culture of a ward
  unit or team and in how staff behave and interact with each
            other and with patients clients and carers

           Continue to develop the evidence base
                  Be ready for the future
  HAI and the Quality Strategy
• Quality Strategy ambitions
  – Person centred
  – Safe
  – Effective
• Priority area for improvement
  – integrated programme between SPSP and
    HAITF to reduce HAI
• Must be able to
  – demonstrate how HAI deliverables will
    support Quality Strategy ambitions; and
  – demonstrate how greater integration in
      HAI and the Quality Strategy:

• Greater synergy with SPSP

• Revised HAITF Governance construct

• Horizon scanning: emerging organisms and AMR

• Focus beyond hospital setting

• Quality Strategy measure – prevalence of infection

• HEAT target development

• Spending review
“Now this is not the end. It is not even
 the beginning of the end. But it is,
 perhaps, the end of the beginning”
   Rapid Stocktake Score lowest 1 to 4
                          National   Your
Clear vision & strategy
Clear Accountability
HAI stock take        Now                                              Next

Vision/picture        Target led Programme – Action plans achieved     Owned and integrated with QS and SPSP
                      a lot                                            Maintain gains but embrace the health system
                      Hospital focussed                                – interfaces and hand offs of care most risk
                      Responding to a „problem;                        Horizon scanning
                      Reactive                                         Shift to prevention Never events lead the
                      Good science                                     science

Leadership            From the centre with networked leaders locally   Bottom up, clear & distributed – at every level
                      Integration strategically is variable            – owned by all – seen as a corporate issues
                      Champions have made a difference                 Leading the field internationally
                      Clarity re ICM IPCP                              Refresh HDLs

Partnerships          Lots of committed expert players &               Revision of HAITF to bring clarity regarding
                      organisations                                    role & contribution of partners & getting
                      Professional engagement through HAITF            expertise more focus on delivery

Accountability/part   Accountability better but compliance driven      Need to focus on Individuals and teams
                      Engagement at all levels including patient       point of care to board clear as are cross team/
                      Stronger SCN input                               agency/environments acc
                      ICTs good input but needs clarity                Stronger ICT input facilitative shared
                                                                       outcomes & results
                                                                       Strong Moral imperative

Competence            Building competence locally – Hand washing etc   Preventive patient flows
                      organisational competences through IIIP          Continue UK wider work on general *
                      Patient movement & management issues are         specialist competences Prevention
                      emerging as key issue                            competences for mangers – bed movement

Measurement/policy    Measurement robust                               Links to care governance, QS & ehealth
                      Lots of policy & guidance                        Rationalise policy & guidance

Monitoring            Improved – static approach top data –statistic   Using data as knowledge for action and
                      owned by others                                  improvement of performance

Assurance             More robust                                      Strengthened to include whole health
                                                                       community & users
                                     Leadership Challenges
             Consolidation of Money                        AND            Gap between supply and demand
            Diversity between Boards                       AND                Commonality of constraints
             Emphasis on Prevention                        AND                             Control
     Continued dominance of the hospital                   AND           Policy drive for care closer to home
                Sustaining the gains                       AND               Getting ready for new threats
             Reliance on IPC Experts                       AND                         Need to empower
   More well-educated, more well-informed                  AND         Many patients lacking information and
           and confident patients                                                   confidence
    Demand for high technical competence                   AND         Continuing need for “human qualities”
         and “scientific rationality”
      Blurring of role boundaries & team                   AND            Separate occupation/professional
                   based care                                             traditions, organisations & public

     Continuation of old moral certainties                 AND        Moral uncertainties in new environments
Adapted from “Nursing Towards 2015
Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015”
(Longley, Shaw, Dolan, 2007)
NMC Publishing
Ambition to Action



                                use of levers

                 support from
    Its hard & its hard all the time

 Leadership in this context can feel like

“building an advanced aircraft , whilst
 it is flight, whilst it is being designed
      & whilst it is being shot at …”
      General David Patreus 2010
Future focussed
                       Industrial age medicine

     Professional                                Secondary

                     Information age health care
                                                     Individual Self care
                                                   Friends and family
                                                 Self help networks
Professionals as
       Professionals as
       true partners
           Professionals as
                 Industrial age                               Information age
Provider orientated                               User orientated

Inputs orientated                                 Outputs orientated

Hierarchical clinical teams &departmental silos   Collaborative/virtual teams with true
Power concentrated – in professions & managers    Power sharing with staff patient & communities
                                                  as partners
Enforced compliance – PM policies, procedures &   Bottom up standards setting & robust
checks                                            assurance
Defensive conservative                            Open to review Open to change

Self care infrequent                              Self care promoted

Carers ignored                                    Carers valued and supported

Reactive single episode provider driven           Preventative Anticipatory integrated H& S care
Real change in real organisations is intensely personal and enormously
political. ” Nadler 1998

Organisations are microcosm of society as a whole with the
same power structures, differentials inequalities
Lymbery (2006) described the vast differences in power and
culture between various occupational groupings, and the
inherently competitive nature of professions jostling for territory
in the same areas of
The Four P‟s
Its not enough to talk about SABs
   targets and patient safety….

   Come my people
  let us kill the SABs

Picture – establish a clear
  direction and end point
People need the story that gives meaning beyond
           Contact hearts and minds
                Make it personal
                 Make it visual
      Process &
Make sure the processes at every
  level are clear & understood &
 that people understand how the
process links clearly to the picture
            & purpose
   Right sort of people in right sort of
       groups – to avoid problem
                  Type                      Purpose
Informational            Gather to exchange important information and
                         maintain alignment
                         Meet with leader to hear about strategic
                         direction & tactics
Consultative             Small groups bought together to advice the
                         leader on key issues and decision
                         Provide information and insight debate issues,
                         a ct as sounding board- don‟t make decision
Coordinating             Meet to coordinate activities or progress
                         Team is interdependent and meet often

Decision making          Assemble to make important decisions
                         The most complex team often in need of a
                         compelling direction. A robust structure,
                         contextual support and coaching
            Make people actors not characters –
Ensure they can see their unique contribution to the whole
Articulate expectations of every person at every level & be
          Make sure they know other peoples part
                                Self Audit

    “We found that successful leaders cultivated a culture of clinical
     excellence and effectively communicated it to staff; focused on
  overcoming barriers and dealt directly with resistant staff or process
 issues that impeded prevention of HAI; inspired their employees; and
  thought strategically while acting locally, which involved politicking
 before crucial committee votes, leveraging personal prestige to move
    initiatives forward, and forming partnerships across disciplines.
Hospital epidemiologists and infection perfectionists often played more
  important leadership roles in their hospital‟s patient safety activities

                      than did senior executives.”
      Reference: Saint SS, Kowalski CP, Banaszak ‐ Holl J, Forman J,
       Damschroder L and Krein SL. The Importance of Leadership in
      Preventing Healthcare‐Associated Infection: Results of a Multisite
    Qualitative Study. Infect Control Hosp Epidemiology. 2010;31:901-907
        Know yourself

How do you respond to stress ?

        Try Hard
         Be Perfect
Using people Ken Thompson 2010
• Mediocre leaders play draughts with
  their workers – they assume we all move
  in the same way and are motivated by the
  same things.
• Good leaders play chess – they learn
  what's unique about each person and the
  best way to energise us.
Leadership Toolkit this is mine
       whats yours ?

 Herons 6       TA
interventions          Four Ps
     Get coaching & feedback
Open to you closed to    Open to you and others

Closed to you & others   Closed to you open to
                              RCN 2008
•   This nonspecific guidance may at first seem intangible and perhaps even unhelpful.
•   However, this review has identified a number of „risks‟ for infection and infection
•   problems. None may be sufficient to cause problems and their removal may not be
•   sufficient to rectify problems. Indeed in some cases (for example high turnover) there
•   be no direct remedial action. However, awareness of these risks provides the
    potential to
•   prioritise interventions and take preventative actions before harm comes to patients:
•   • Weak or negative clinical leadership at ward level
•   • Weak or negative clinical leadership above ward level
•   • Absence of clear lines of clinical management and responsibility from ward to board
•   • Excessive „span of control‟ among clinical leaders
•   • Unclear roles and responsibilities for infection control
•   • Lack of clear policies and active support for training
•   • Absence of an effective multidisciplinary infection control team perceived as
•   positive leadership at ward or unit level
•   • High staff turnover
•   • High use of bank or agency staff
•   • Low staff morale
•   • High patient throughput
•   • Workload not matched to available staffing
•   • High bed occupancy
“This is how change happens.
        It is a relay race.
  Our job is to be part of the
 race, and then we pass it on,
and then someone picks it up,
      and it keeps going.

    And that is how it is”

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