Alan Bedford Consulting

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Alan Bedford Consulting

• A Chief Executives Perspective
• Alan Bedford
• Tackling healthcare associated infection cannot
  be left to clinical staff alone senior
  management commitment, local infrastructure and
  systems are also vital ---Winning Ways-Action
  Area 6 key issue

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Alan Bedford Consulting

• My Background
• An NHS CEO for thirteen years ( community,
  mental health, acute , and commissioning)
• Led , as acting CEO, Buckinghamshire Hospitals
  NHS Trusts recovery after critical 2006
  Healthcare Commission review of C.diff outbreaks
  at Stoke Mandeville Hospital
• Chair , East of England SHA C.diff Support team
• My mother died with C.diff last year , so seen
  the impact first hand

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Alan Bedford Consulting

• Its Very Serious Stuff
• It must be a real priority. No room for blind
  eyes, or complacency
• Last year, 67 Trusts had a worse C.diff rate than
  the worst year investigated by the Healthcare
  Commission at Bucks Hospitals. There but for the
  ..
• Even those Trusts better than average have too
  much C.diff
• We must reduce the numbers right down.

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Alan Bedford Consulting

• Key Healthcare Commission findings at Stoke
  Mandeville
• Management action insufficient
• Focus on national targets over safety
• Lack of isolation facilities physical
  environment at Stoke
• Nurse staffing issues
• Inadequate staff training on infection control
• Over-complex governance arrangements
• Clinical concerns not reaching the top

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Alan Bedford Consulting

• The Action Plan covers
• Antibiotic management
• Improving dehydration/ fluid records
• Isolation practice
• Standards of cleanliness/hand hygiene
• Mandatory IC training
• Integrating IC with routine work and audit
• IC integral to clinical governance
• Bed management policy eg transfer
  criteria/isolation/escalation/ingle sex
  accommodation
• Nurse staffing levels
• Putting patient safety first
• Governance/risk management arrangements
• Improving complaints management
• The italicised items all contain very significant
  management actionshowing that its a whole
  organisation issue

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Alan Bedford Consulting

• Getting it right is a clinical and managerial
  task
• The Board has to understand, support and
  performance manage
• For example, this means having information about
  
• - Numbers of infections
• - Where
• - Which are hospital caused
• - What causes ( eg R.C.A. of all
  MRSA
• bacteraemia/C.diff cases)
• - Isolation policy breaches
• - Trends
• -Governance arrangements
• -Training compliance
• -Actions being taken and the
  results

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Alan Bedford Consulting

• Health Act 2006 Code of Practice
• describes duties on Trusts
• To protect
• To have proper management systems around IC
• To assess risks and act accordingly
• To provide and maintain clean environment
• To provide info on HCAI to patients and public
• To ensure everyone cooperates
• To ensure adequate lab support
• To adhere to policies and protocols
• To protect staff from communicable disease, and
  train them
• Again, very substantial, and non negotiable
  management action

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Alan Bedford Consulting

• Health Minister Lord Hunt to NHS Confederation
  2007
• The role of the board is very important.
  (you) may feel this is a clinical area, but
  boards are accountable. It is the Chairs and the
  Chief Executives that are in the firing line. Let
  there be no doubt that their role is to assure
  themselves that their organisation is giving
  appropriate attention to safety and quality. In
  terms of accountability and public reputation,
  the public would expect Boards to show
  leadership. Strong executive and non-executive
  leadership is crucial to ensuring the behavioural
  and cultural changes occur to keep infection
  rates down.

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Alan Bedford Consulting

• What all DIPCs should expect
• Direct access to CEO, and Chair if dissatisfied
• A CEO who demonstrates a personal interest
  through visible action..
• and who is personally supportive
• Prompt action by operational leaders when
  infection control measures have to be introduced
  or enhanced
• Personal support from the executive when clinical
  compliance is being challenged
• A Board which has the information on the earlier
  slide
• To be kept in the loop always on service change
  and plans
• To be treated as a very major player
• Sufficient time to do the job
• Admin support

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Alan Bedford Consulting

• What DIPCs need to do/be in return
• Good on infection control!
• Authoritativemake presence heard
• Confidentnot afraid to, and increasingly good at
  , challenge
• Informed , and informing
• Comfortable with top managersunderstand their
  world too
• Good on processfollowing through plans
• Clear about advice, but realistic
• Persistentkeep going if you are right
• Multidisciplinarycleaners to A consultants
• Health community focussed

• What DIPCs need to do/be in return
• Good on infection control!
• Authoritativemake presence heard
• Confidentnot afraid to, and increasingly good at
  , challenge
• Informed , and informing
• Comfortable with top managersunderstand their
  world too
• Good on processfollowing through plans
• Clear about advice, but realistic
• Persistentkeep going if you are right
• Multidisciplinarycleaners to A consultants
• Health community focussed

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Alan Bedford Consulting

• Appointing a DIPC
• IC Clinician, or Board member?
• Look at the spec/competencies
• Scenario A.
• Microbiologist, say, brilliant clinically, but
  not so confident on managerial/political/influenci
  ngit maybe best to go for medical or nurse
  director as DIPC
• In this case, the board member accepts the full
  role of DIPC
• Much would, of course, be delegated to the lead
  IC doctor, but the two roles must be spelt out in
  writing ( and communicated) to ensure
  nothing falls between them

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Alan Bedford Consulting

• Appointing a DIPC contd
• Scenario B.
• Great consultant microbiologist who has the
  confidence and influencing skills, or can develop
  them soonmaybe go for the consultant as DIPC
• In the latter case there must be a lead exec. on
  IC
• who must work hand in glove with the DIPC
• If the lead exec is not the CEO , direct access
  to the CEO must be there
• Again the roles need spelling out formally , and
  communicated
• We are talking about a life and death function,
  so the decision needs to be made carefully no
  time for fudges

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Alan Bedford Consulting

• Its all about the Cs
• Compliance
• Consistency
• Communication
• Trusts that do the right thing consistently,
  monitor and ensure compliance with IC and
  governance good practice, and ensure that this is
  thoroughly communicated get less infection.

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Alan Bedford Consulting

• And finally ( for DIPCs and CEOs)..
• Dont assume anything is working!
• Compliance is everything in the fight against
  HCAI.
• Dont accept anything less
• Deviation can have very severe consequences for
  patients
• Make sure there are systems in place to check
• and to take action with non compliance
• BUT MOST OF ALLGO and LOOK and TALK