CEO takes it personal after baby deaths in outbreak
September 1, 2008 4 minutes read
CEO takes it personal after baby deaths in outbreak
Health system cuts MRSA infection rate by 35%
How serious did Charlotte, NC-based Novant Health decide to take MRSA infections after an outbreak among premature infants left the hospital with two dead babies? Posters went up on the walls that featured a child in a hospital bed with the caption, "You could kill him with your bare hands."
Such a direct approach may make some feel uncomfortable, but Paul Wiles, Novant Health CEO, was way beyond that emotion. "I realized my role as CEO must be creating a culture of hand hygiene and infection control because nobody else but me could make that happen," he says.
Already devastated by the baby deaths, he was told the most likely explanation was transient colonization on the unwashed hands of health care workers — a classic model of cross-transmission fueling an outbreak. Two of 18 infected infants died from complications related to being born prematurely and infection with methicillin- resistant Staphylococcus aureus (MRSA).
"What an enormous cost to pay for neglecting the very simplest of precautionary measures of infection control," he says. "It hit me a number of different ways. One was just pure tragedy of the loss of a child. The MRSA probably came from outside the organization — but that's not important. It got inside our nursery. The fact that we allowed it to spread was clearly our culpability."
The true cost had been in human life, but there also was the significant loss of honor and pride among clinical staff who personally accepted their failure amid careers they devoted to saving lives instead of taking them, he adds. "I know some of the nurses that work in that unit. [I saw] the emotional devastation that this had on them," he tells Hospital Infection Control.
The combination of seeing anguished family members and staff because of such a basic breach in infection prevention led Wiles to demand a profound change in hospital culture. "I guess probably every hospital administrator has heard that we only do [hand washing] right about half of the time," he says. "Behavior is hard to change, but I am not going to tolerate that anymore. We know what the right thing to do is. Creating a behavioral change among thousands of people is hard to do, but on behalf of our patients and employees, we have to do it. I said, 'I don't accept that as being the status quo because 'it's too hard to do.' We're going to change that."
As a result, Novant has dramatically increased hand-washing compliance from 49% to 98% and decreased MRSA infection rates by 35% from 2005 to 2007. Staff implemented a hard-hitting, systemwide campaign that changed the health system's culture and spared an estimated 94 patients from the medical complications of MRSA. In the first six months of 2008, the health system's MRSA infection rate has continued to fall. The campaign includes assigning hand hygiene monitors to roam hospital halls and educate doctors and nurses who do not properly wash their hands. (See hand hygiene compliance form.) The data are aggregated and widely distributed.
"They report to everybody," Wiles says. "A department head can know what observations took place in their department yesterday." The culture change means everyone is accountable and dismissal is an option for repeat offenders. "If you can't practice good medicine, we don't need you," he says." There might be somebody that does, but we don't. It is a form of harm as much as giving the wrong medication."
The power of storytelling
"The biggest initiative that took place was a concerted effort toward high levels of hand hygiene [compliance]," adds James W. Lederer, MD, medical director for clinical improvement at Novant. "Many organizations have been on this trail for years and years. Really, what took place at the end of '04 and the beginning of '05 was a focus by the entire organization [to improve hand hygiene]. It was a focused effort and it really went across all facilities. We took the hard line, not the warm and fuzzy. However, an important [feature] was the power of storytelling about what we are doing and why we were doing it. It was the event. It was the people involved. It was the outcomes that were experienced by these patients."
An expert in infectious diseases, Lederer says it is unusual for a CEO to get directly involved in infection prevention. "You don't expect someone at that level is going to get down into the minutiae where I live," he says. "But he was devastated by this outbreak."
The monitors do direct observation of hand hygiene compliance, but the process is more a driver for culture change than trying to catch every break-in technique, he notes. "Admittedly, it's predominantly Monday through Friday but they have some 'pop' visits weekends and nights," Lederer says. "The mindset I have is if the overwhelming [majority are complying], you get the trickle-down effect to weekends and nights. Today, I put on a seatbelt without thinking. That is what we are trying to do — change the culture to where [hand hygiene] is an unconscious activity."
Novant had always used the traditional resources for hand hygiene education that many hospitals in America use today, but it was obviously not enough because it never changed behavior, says Jim Tobalski, senior vice president of marketing and communications at Novant Health. Tobalski was charged with spearheading the employee educational campaign and helping the clinical team improve hand hygiene compliance. He admits that he initially had no idea how to accomplish the goal. "The project was huge, but I knew to be successful, we had to scrap what I refer to as the traditional 'Mr. Scrubby Bubbles' approach and do something totally different," said Tobalski, a "Seinfeld" TV show fan whose ultimate decision to follow "Seinfeld" character George Costanza's example and "do the opposite" paid off.
(Editor's note: Novant's posters, billboards, and educational materials are available at free of charge at www.washinghandssaveslives.org/materials.html.)
How serious did Charlotte, NC-based Novant Health decide to take MRSA infections after an outbreak among premature infants left the hospital with two dead babies? Posters went up on the walls that featured a child in a hospital bed with the caption, "You could kill him with your bare hands."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content