GSAS Sponsored Seminar Workshop Professor Charles Egbu PhD University of Salford UK Qatar National Convention Centre Doha Qatar 14 th June 2014 2 HAI in Context FM in Context ID: 934225
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LEARNING LESSONS FROM IMPROVEMENT OF MANAGEMENT OF HEALTHCARE ACQUIRED INFECTIONGSAS Sponsored Seminar / Workshop
Professor Charles Egbu PhD University of Salford, UK
Qatar
National Convention Centre, Doha – Qatar
14
th
June 2014
Slide22HAI in ContextFM in ContextThe Role of FM in the Control of HAI
The Role of Knowledge Management and Knowledge Mapping in Controlling HAIPerformance Management and FM in the Control of HAI
Structure of Presentation
Slide33HAI by definition means the infection was neither present nor incubating at the time of admission but has developed during the course of a stay in hospital or other facility (Haley, 1986 as cited in Horton and Parker 2002; Comptroller and Auditor General, 2000; Public Health Laboratory Service, 2000; Scottish Executives Action Plan, 2002; World Health Organisation, 2002; Montana State Hospital, 2003).
Healthcare Associated Infection (HAI)
Slide4Tranquil Gardens
Nursing Home
Home
Care
Acute Care Facility
Outpatient/
Ambulatory
Facility
Long Term
Care Facility
The Healthcare System
More than Just Hospitals
Source: Alice
Guh, MD, MPH – (CDC)
Slide5She was progressing in the neonatal intensive care unit until she developed a bloodstream infection related to her umbilical catheter.
Your baby was born prematurely.
Source: Alice
Guh, MD, MPH – (CDC)
Slide6The surgery goes well but he later dies in a nursing home of a MRSA wound infection that developed after surgery.
Your father has open heart surgery.
Source: Alice
Guh, MD, MPH – (CDC)
Slide77HAI is recognised as presenting a significant problem in terms of quality of care and cost for hospitals, governments and consumers in most countries (Department of Human Services, 1998). In prevalence surveys of hospital infection in the UK, and other developed countries, the acquired infection rate was approximately 10% (which means approximately 10% of patients in hospitals at any one time have acquired an infection from
hospitals).The control of HAI exists as a major concern, and the high frequency of HAI is seen as evidence of poor quality of health service delivery, which has significant cost implications (WHO, 2002).
Healthcare Associated Infection (HAI)
Slide88The costs associated with HAI have medical and economic ramifications. HAI has ramifications for patients and healthcare
facilities; and associated costs are exacerbated during an outbreak which also affects patients’ confidence in the service. The economic consequences include lost bed days and increased work load with some estimates showing that 380,000 bed days per annum are lost to HAIs. This is equivalent to 1000
hospital beds
and associated staffing input being wasted in dealing with HAI related delays in discharge
.
There
is also the social and personal burden that unnecessary illness and complications place upon patients and their families
.
Healthcare Associated Infection (HAI)
Slide99 Infection control is everybody’s business, thus, there is a need for better collaboration and coordination among clinical and non-clinical teams to come up with an effective and ‘seamless’ infection control practices.
Infection Control
Slide1010HAI is everybody’s business
Clinical
Doctors
Nurses
Microbiologists, etc.
Construction
Engineers
Architects, etc.
FM
Cleaning
Catering
Waste Mgt
Maintenance
Estate engineering
Strategic management
Healthcare managers
Policy makers, etc.
Different User Roles
Slide1111There are many reasons why patients develop HAI. Some of these relate to the immunocompetence of the patient, while others reflect the environment in which the patient is nursed or the skill of the surgeon and the team conducting their care. Facilities Management (FM) services have a significant role in controlling HAI. The design and maintenance of the building is important to provide a risk free environment for the patients as well as for the healthcare workers.
Healthcare Associated Infection (HAI)
Slide1212 From a Facilities Management perspective, the Design
and Maintenance of the building is important in providing a risk-free environment for the patients as well as for the healthcare workers. Design considerations include ventilation requirements, patient accommodation, facilities such as hand wash basins and toilets and the materials to be used for the surfaces.
FM and HAI
Slide1313‘Effective cleaning of hospital wards is essential for the health and safety of both patients and staff, and makes an important contribution to the quality of care patient’s experience. However, there is a growing perception that standards of cleanliness in hospitals have been declining. Domestic services play a key part in minimising the risk of hospital acquired infections, which have serious consequences for patients and lead to significant costs to the NHS
’ (Auditor General, 2000). HAI AND CLEANING
Slide1414“A safe environment (the estate), clean surroundings and an appropriate diet (hotel services) are integral parts in the diagnosis, treatment and recovery of those who are ill “. Rees (1998) If HAI is to be controlled effectively,
it is essential to focus on non-clinical areas such as Facilities Management (FM)” as well (Meers et al, 1992; Horton and Parker, 2002). FM and HAI
Slide1515
The Principles of a Safe Environment (Source: Horton and Parker, 2002)
Slide1616FM in healthcare usually includes a myriad of services. These are mainly in two categories: - hard FM and soft FM.
Hard FM relates to management and maintenance of property.The built environment, including infrastructure facilities such as estate and property, indoor air, structure and fabric, water supply, electricity and telecommunication systems come under the first category (hard FM);
Soft
FM includes the management of support services.
Catering
, cleaning, waste management, security, and
laundry.
Hard and Soft Facilities Management
Slide17Integrated Facilities Management
Core Business
Accounts
IT
Personnel
Purchasing
Distribution
Transport
Property & Facilities
Focus on Core Business
Reduced Costs
Increased Flexibility
Improved Service Quality
Introduce Best Practice
Establish a Vehicle for Change
Drivers for ChangeRisk!Source: Ian R Fielder
Slide1818Effective design and maintenance of water supply systems – The Control of
Legionella
Design and maintenance of inanimate surfaces – Minimal dust
accumulation
The
space around beds – control of cross
infection
HVAC
design and maintenance – control of airborne
infection
The design of visible and accessible
hand-washing
facilities – control of contact
transmission
HAI AND THE DESIGN, CONSTRUCTION AND MAINTENANCE OF FACILITIES
Slide19KNOWLEDGE MANAGEMENT AND KNOWLEDGE MAPPING
19
Slide2020“Around 15% of HAI could be avoided through strengthened arrangements for prevention and control, and better application of existing knowledge and good practice”.
Department of Health. (2001). NHS Performance Indicators: A Consultation http://www.doh.gov.uk/piconsultation/haicar.htm
HAI and Knowledge Management
Slide2121A lack of co-ordination and integration of knowledge sources exist for the control of HAI. There is also paucity of literature for facilities management professionals/staff in infection control, even though they have an important role to play in the control of HAI.
HAI and Knowledge Management
Slide22Knowledge Management
The management of any process of mapping, creating, acquiring, capturing, transferring, sharing and using knowledge wherever it resides in order to meet existing and emerging needs, to identify and exploit existing and acquired assets and to develop new opportunities.
Slide23Knowledge Mapping and MapsKnowledge mapping is defined as the process, methods and tools for analysing knowledge areas in order to discover features or meaning and to visualise these in a comprehensive, transparent form, such that the business-relevant features are clearly highlighted.
Speel et al.(1999)Knowledge mapping techniques aim to track the acquisition and loss of information and knowledge.
It explores personal and group competencies and illustrates how knowledge flows throughout an organisation or ‘network’.
Slide24Knowledge MapsA knowledge map describes what knowledge is used in a process, and how it flows around the process.
It describes:who has what knowledge (e.g. tacit/explicit), where the knowledge resides (e.g. individuals, infrastructure
), and
how the knowledge is transferred or disseminated (social)
IBM Global Services- Technique Paper 2000
Knowledge maps
are created by transferring certain aspects of knowledge into a graphical form that is easily understandable.
Slide2525
Routine
Rationale
Technique
Staff/carer issues
Equipment/services
Hand washing
Aseptic
Surgical
Agents
Skin care
Compliance
Sinks
Taps
Cleaning
Waste
Rationale
Technique
Staff/carer issues
Equipment/services
Hand Hygiene
Surgical
Agents
Sinks
Taps
Cleaning
Waste
Example of a Knowledge Map
Slide2626‘Performance Management (PM)’ was first used in the 1970s, but it did not become a recognised process until the latter half of the 1980s (Armstrong and Baron, 1998).
PM is mostly identified as a system which enhances individual performances to support or achieve organisational goals. PM cannot be defined in the absolute and that its meaning is contextual in terms of both individuals and activities. (Adair et al; 2003)
Bartely
(2000) has
recommended that PM
is essential to assess the level of adoption of control of HAI standards in FM services.
Performance Management
Slide2727Little has been researched or published in the areas of performance management in healthcare organisations, and even less so in the context of domestic services.There is evidence of a lack of common understanding of what is meant by performance, or how performance could be measured in practice, especially with regard to the control of HAI in domestic services.
Performance Management in Healthcare Organisations
Slide2828Balanced Scorecard (BSC). Developed by Kaplan and Norton
European Foundation Quality Management (EFQM) model PQASSO (Practical Quality Assurance System for Small Organisations)“The Big Picture (an organisational improvement framework and diagnostic tool for identifying strengths and weaknesses within an organisation or programmes of work)
Investors in People (a
UK national
standard for improving organisational performance by training and developing people to achieve organisational goals).
Performance Management - Approaches
Slide2929The UK national Performance Assessment Framework (PAF)six areas of performance
Health improvement; Fair access; Effective
delivery of appropriate
healthcare
E
fficiency
;
Patient/carer
experience; and
Health
outcomes of NHS
care
PAF, arguably,
does not give much attention to infection control as part of their overall assessment in hospitals
Performance Management – UK NHS
Slide3030PM approaches in-use in the control of HAI in domestic services
Audits by domestic service
Audits by infection control teams (ICT)
Environmental audits
Audits by the National Audit Office
Patient satisfaction survey
PA for domestic managers
Benchmarking techniques
PA for domestics
Personal Development Plans
PAF by the NHS
Programme evaluation techniques
ISO 9001:2000
BSC
EFQM (Based on 412 completed questionnaires from domestic managers and infection control team members across England and Scotland)
Slide3131PM is essential to assess the level of adoption of control of HAI standards in FM services.
Measure progress towards achieving corporate objectives and targets.Promote the accountability of service providers to the public and other stakeholders.Compare performance to identify opportunities for improvement.
Performance
indicators may be used to identify opportunities for improvement through comparison both within the organisation over time or between different units or organisations.
Promote service improvement by publicising performance level.
Performance Management (PM) and HAI
Slide32