1. Aiming for Zero Tolerance: Are You Ready to Be a Change Agent? Kathleen Meehan Arias, MS, CIC Arias Infection Control Consulting, LLC Crownsville, MD APIC Greater Cincinnati-Dayton Fall Symposium October 1, 2008

2. What does zero refer to? Zero tolerance? Zero infections? Eliminate all HAIs? Eliminate specific HAIs? A marketing campaign?

3. Were headed for Dodge City…

4. Change Agent Google: 748,000 hits for change agent in 0.05 seconds Encarta: Somebody or something that brings about, or helps to bring about, change Wikipedia: lacks change agent page, but…. http://encarta.msn.com/dictionary

5. I know that you're afraid. You're afraid of us. You're afraid of change. I don't know the future. I didn't come here to tell you how this is going to end. I came here to tell you how it's going to begin… I'm going … to show you… A world where anything is possible. Where we go from there is a choice I leave to you. --Neo, The Matrix

6. The IP as Change Agent A person that effectively redirects the capacities of individuals or organizations to implement change --Arias

7. Do we need change?

8. HAIs: Worldwide Problem Health care-associated infections (HAIs) are a global problem Affect patients, their families, and healthcare system At any time, HAIs affect over 1.4 million people worldwide Tikhomirov E. WHO Programme for the Control of Hospital Infections. Chemiotherapia 1987;3:148–151

9. Burden of HAIs--U.S.,2002 1.7 million infections in hospitals 1.3 million outside of ICUs 4.5 per 100 admissions 99,000 deaths associated with HAIs 36,000 pneumonia 31,000 bloodstream infections (BSI) Klevens et al. Pub Health Rep 2007;122:160-6

10. That amounts to one HAI-related death every 5.3 minutes!

11. Culture The collection of values, beliefs and assumptions that guides behaviors 1 An organizations pattern of response to problems and opportunities 2 1.Pronovost. Qual Saf Health Care 2003;12:405-10 2.Westrum. Qual Saf Health Care 2004;13(Suppl II):ii22-ii27

12. Beliefs and assumptions guide behaviors

13. Belief and Assumption One-third HAIs are preventable Most HAIs are inevitable outcome of complex health care and sicker patients Haley RW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121:182-205.

14. Recent Findings Higher proportion of HAIs can be prevented ventilator-associated pneumonia central line-related bloodstream infections In 2002, 99,000 deaths related to HAIs: 36,000 pneumonia and 31,000 BSIs Harbarth S, Sax H, Gastmeier P. J Hosp Infect. 2003:54:258–266

15. The past is over. G.W. Bush

16. We Can Do Better Many hospitals, professional associations, and organizations have implemented major initiatives to promote HAI prevention Hospitals that have committed to infection prevention have made it happen

17. Many Success Stories Individual hospitals-U.S. 1 : Allegheny General Hospital (Pittsburgh, PA) - CLA-BSI in neonates Hospital of St. Raphael (New Haven, CT) - CAUTI Pittsburgh Regional Health Initiative Richards C et al. Emerg Infect Dis; Mar-Apr 2001

18. Many Success Stories Individual hospitals – Netherlands 1 : 5 hospitals reduced SSI rates Institute for Healthcare Improvement Your organization? Geubbels E et al. Am J Infect Control; 2004;32:424-30.

19. Relax--Change is Good

20. Essential Elements for Change Evidenced-based practices Measurement and feedback of information Collaboration between all levels Leadership support Continuous learning and reflection Everyone held accountable

21. Guiding Principles for Change Agent Go where the energy is Get the right people to the table Build on the organizations history and collective intelligence Baird-Wilkerson S. A monograph on creating organizational change using a living-systems approach. 2003

22. Guiding Principles for Change Agent Understand the processes that produce the result Share information Move from silos to collaboration Baird-Wilkerson S. A monograph on creating organizational change using a living-systems approach. 2003

23. Roles of the Change Agent Reflector Provocateur Confronter Space keeper Baird-Wilkerson S. A monograph on creating organizational change using a living-systems approach. 2003

24. The Reflector Assists organization to engage in self- reflection Self-reflection of change agent Self-reflection of group

25. The Reflector: Self-Reflection Understanding of what is happening depends on change agents capacity for reflection and learning Shaped by professional and personal experiences Must have self-awareness of impact on others impact that others have on self

26. Lets shoot the messenger! Hostile feelings toward those who introduce change View this as normal human behavior Change agent must: Respond reflectively, openly, and honestly rather than defensively, judgmentally, or personally

27. The Reflector: Group Reflection Help individuals see who they are Based on what they do not who they say they are or what they say they do Help separate perception from reality Change agent must be: Active listener Non-judgmental

28. The Provocateur Raises issues to incite a response The provocateur is: A person who provokes trouble, causes dissension, or the like; agitator 1 A person hired to make trouble 2 One who provokes 3 1. Dictionary.com; 2. Online Etymology Dictionary; 3. Merriam-Webster

29. The Provocateur Measurement drives performance Show me the data! Get people engaged: Who are they in relation to the data? How do they have the ability to change the data/results?

30. Sometimes its not so easy…..

31. Show Me the Data….

32. The Confronter Unveils what others refuse to see The confronter is: One who confronts Confront: to challenge; to cause to meet or bring face-to- face (Wiktionary); to bring together for examination or comparison (Dictionary.com)

33. The Confronter Unveils what others refuse to see Have you asked people how often they practice hand hygiene?

34. The Confronter Unveils what others refuse to see Have you asked people how often they practice hand hygiene? Have you measured how often they practice hand hygiene?

35. ASM survey, 2007 What they say: 92% adults say they always wash hands after using public restrooms What they do: 77% observed doing so www.asm.org

36. The Space Keeper Supports an environment that promotes honest dialogue

37. The Space Keeper Set the stage: physical and mental Dont let people escape! Foster creativity: ask question rather than suggest answers

38. The Space Keeper Deliberately encourage discontent with the status quo Create conditions in which every person can design systems and processes that produce outcomes that may seem unimaginable

39. Skills Needed Communication Leadership Ability to see the big picture Interpersonal Listening, negotiation, relationship building, conflict management Motivational

40. Assume the Role Challenge status quo Frame a specific compelling vision Articulate vision so others can embrace it Listen, listen, listen use ears and eyes: read faces and body language to understand what people are not saying in words but may be expressing or suppressing

41. Assume the Role Identify the right talent & build teams with needed skills Leadership, interpersonal relationship, communication, knowledge of the organization and the processes Lead the way

42. Assume the Role Focus on Goals rather than roles Collaboration rather than competition Ideas rather than personalities Achieving the desired outcome

43. How do you know if you are successful?

44. Better patient outcomes Lower HAI rates Reduced transmission of infectious agents Increased compliance New language adopted by others Infection control becomes infection prevention

45. What did she say? HAIs are worldwide problem HAIs are not an inevitable outcome Change is needed to eliminate HAIs Change agents play many roles The IP is in an ideal position to serve as a Change Agent

46. Final Note If you think you're too small to be effective, youve never been in bed with a mosquito.