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Making Sense in the Dark… I changed the CICU culture; or did I really?
Eric M. Graham, MD
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“Organizational culture is the pattern of basic assumptions that a given group has developed that have worked well enough to be considered valid, and therefore to be taught to new members as the correct way to perceive, think, and feel in relation to those problems." -Edgar Schein. Edgar Schein, the MIT professor that many consider to be the "father" of organizational culture research
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“Organizational culture is the pattern of basic assumptions that a given group has developed that have worked well enough to be considered valid, and therefore to be taught to new members as the correct way to perceive, think, and feel in relation to those problems." -Edgar Schein. “This is how WE do it” Edgar Schein, the MIT professor that many consider to be the "father" of organizational culture research
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Changing an organization’s culture is one of the most difficult leadership challenges.
Steve Denning, Forbes 7/23/11
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Changing an organization’s culture is one of the most difficult leadership challenges.
Steve Denning, Forbes 7/23/11 As a manager, you may have the power to change your organization’s policies with the stroke of a pen. And you may have the ability to hire, fire, promote and demote people with relatively little effort. Adapted in part from “The Wall Street Journal Guide to Management” by Alan Murray, published by Harper Business.
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Changing an organization’s culture is one of the most difficult leadership challenges.
Steve Denning, Forbes 7/23/11 As a manager, you may have the power to change your organization’s policies with the stroke of a pen. And you may have the ability to hire, fire, promote and demote people with relatively little effort. But changing an entrenched culture is the toughest task you will face. To do so, you must win the hearts and minds of the people you work with, and that takes both cunning and persuasion. Adapted in part from “The Wall Street Journal Guide to Management” by Alan Murray, published by Harper Business.
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The Right Leaders Intense belief in the cause
Leverage belief to rally others Vision Purpose
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I changed the culture in our CICU to a culture of safety…..
Share with you how I changed the culture in our CICU to a culture of safety
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Confessions of a CICU Director
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Confessions of a CICU Director
I didn’t possess any of these characteristics
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Confessions of a CICU Director #1
In 2007, leadership charged us with the task to reduce infections Committee gets formed I’m the most jr ICU attending – so I get put on this committee
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Central Line Associated Blood Stream Infections
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Ventilator Associated Pneumonia
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Our Culture We had outstanding outcomes
We required numerous medical devices: Bloodstream catheters Urinary catheters Endotracheal tubes Justified infections Indwelling medical devices
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SWOT Analysis Strengths Weakness Staff apathy
Highly motivated professionals Outstanding patient outcomes Pride TEAM mentality Senior leadership buy in Staff apathy Inexperienced leader Lack of time/resources Communication about evidence-based policies Opportunities Threats Communication between team & senior leadership Communication with infection preventionist Regular data reporting Create accountability/ownership Change in hospital priorities Crisis management vs. pro-active building ‘Unattainable’ goals leading to team frustration Insufficient ‘change management’ skills Leadership development Staff development
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SWOT Analysis Strengths Weakness Staff apathy
Highly motivated professionals Outstanding patient outcomes Pride TEAM mentality Senior leadership buy in Staff apathy Inexperienced leader Lack of time/resources Communication about evidence-based policies Opportunities Threats Communication between team & senior leadership Communication with infection preventionist Regular data reporting Create accountability/ownership Change in hospital priorities Crisis management vs. pro-active building ‘Unattainable’ goals leading to team frustration Insufficient ‘change management’ skills Leadership development Staff development
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SWOT Analysis Strengths Weakness Staff apathy
Highly motivated professionals Outstanding patient outcomes Pride TEAM mentality Senior leadership buy in Staff apathy Inexperienced leader Lack of time/resources Communication about evidence-based policies Opportunities Threats Communication between team & senior leadership Communication with infection preventionist Regular data reporting Create accountability/ownership Change in hospital priorities Crisis management vs. pro-active building ‘Unattainable’ goals leading to team frustration Insufficient ‘change management’ skills Leadership development Staff development
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SWOT Analysis Strengths Weakness Staff apathy
Highly motivated professionals Outstanding patient outcomes Pride TEAM mentality Senior leadership buy in Staff apathy Inexperienced leader Lack of time/resources Communication about evidence-based policies Opportunities Threats Communication between team & senior leadership Communication with infection preventionist Regular data reporting Create accountability/ownership Change in hospital priorities Crisis management vs. pro-active building ‘Unattainable’ goals leading to team frustration Insufficient ‘change management’ skills Leadership development Staff development
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SWOT Analysis Strengths Weakness Staff apathy
Highly motivated professionals Outstanding patient outcomes Pride TEAM mentality Senior leadership buy in Staff apathy Inexperienced leader Lack of time/resources Communication about evidence-based policies Opportunities Threats Communication between team & senior leadership Communication with infection preventionist Regular data reporting Create accountability/ownership Change in hospital priorities Crisis management vs. pro-active building ‘Unattainable’ goals leading to team frustration Insufficient ‘change management’ skills Leadership development Staff development
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Interventions Children’s Hospital Infection Prevention committee
PCICU interdisciplinary team MD, RN, infection preventionist, RT, CA, EVS, RN Education on “Best Practices” Collect data and disseminate results Timely data Infection prevention education board s Discussed at every staff mtg, ICU M&M, multidisciplinary mtg 2007;
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Central Line Associated Blood Stream Infections
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Ventilator Associated Pneumonia
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Costello JM. Pediatrics. 2008
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unit-based infection control nurse
Costello JM. Pediatrics. 2008
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education for physicians and nurses
Costello JM. Pediatrics. 2008
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real-time feedback on CLABSI data
Costello JM. Pediatrics. 2008
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Implementation of CVL insertion, access, and maintenance bundles
Costello JM. Pediatrics. 2008
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Daily goal sheets on rounds that emphasized timely CVL removal
Costello JM. Pediatrics. 2008
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Reduction from 7.8 to 2.3 infections per 1,000 catheter days
Costello JM. Pediatrics. 2008
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Confessions of a CICU Director #2
Not only could this be done it should be done Nursing champions Rally others Pride Emotional stories
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Peer Pressure…… To really change how a group of people thinks and behaves, it turns out, you don’t need to change what’s inside of them, or appeal to their inner sense of virtue. You just have to convince them that everybody else is doing it.
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PCICU INFECTION PREVENTION TEAM
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Interventions Children’s Hospital Infection Prevention committee
PCICU interdisciplinary team MD, RN, infection preventionist - Champions RT, CA, EVS, RN Identify and respond to emerging threats (Education) Best practice guidelines Annual infection prevention training Frequent infection prevention skills check off Infection prevention rounds 2007;
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Interventions Collect data and disseminate results
Timely data Infection prevention education board s, website, & waiting room Discussed at every staff mtg, ICU M&M, multidisciplinary mtg Recognize/ensure excellence Celebrate wins Align nurses/fellows/manager/director goals Promote staff growth & development 2007;
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Addie Term infant born with HLHS Complicated course Endocarditis
Mediastinitis VAP CLABSI
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Addie Term infant born with HLHS Complicated course Endocarditis
Mediastinitis VAP CLABSI
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Central Line Associated Blood Stream Infections
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Ventilator Associated Pneumonia
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Hand Hygiene Compliance
2012
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MUSC Children’s Hospital Infection Prevention Wins
The Pediatric Cardiac ICU (PCICU) received a PLATINUM level award for achieving 99% hand hygiene compliance. The best in all of MUSC!
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We received the 1st place award for our poster “A PCICU’s Infection Prevention Journey” at the Children’s Hospital Association’s national meeting in 2013
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PCICU Nursing Led Abstract Presentation
Erica Jeffery will be presenting our PCICU’s success in reducing catheter associated urinary tract infections (CAUTIs) “Flushing away catheter associated urinary tract infections” # CAUTI in PCICU Erica Jeffery, RN Co-authors include: Elizabeth Lucey Boyle, Beth Rhoton, Catherine Reeves, Lauren Ruthven, Sonja Muckenfuss, Amanda Schubert, and Eric Graham, MD
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Did I change a CICU to a culture of safety?
Hospital Acquired Infections
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Fundamental Principles
Culture of Safety Just Culture Reporting Culture Learning Culture Professionalism Teamwork Connect to Purpose
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Creation of a Just Culture
Strikes a balance between the extremes of a punitive and blame-free culture Punitive Culture Blame-Free Culture Just Culture
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Reporting & Learning Culture
Report their errors and near misses Acknowledged Worthwhile Easy to use Safe Learn & CHANGE from prior mistakes Professionalism, team work and a sense of purpose
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Keys for the Elimination of Healthcare-Associated Infections
Accountability: Full adherence to prevention recommendations Across care continuum Oversight & monitoring, empowered to report Transparency & sustainability: Collect data and disseminate results Providers & Patients National Healthcare Safety Network (NHSN), use data to move towards targets Identify and respond to emerging threats Recognize/ensure excellence Promote staff growth & development
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Key’s to really changing a culture
Intense belief in your cause Leverage your belief to rally others Encourage diversity Interdisciplinary champions Create an environment that promotes a culture of safety Just culture, reporting culture, & learning culture Look at challenges as opportunities
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Never underestimate the power of peer pressure…..
Everyone is meeting in the bar for drinks before heading to the poster session!
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