This month has me in a very reflective mode as I prepare to begin a new career adventure in clinical finance next month. For the first time since graduating from infectious diseases fellowship, I won’t have day-to-day healthcare epidemiology responsibilities. This piece is a summary of important themes and lessons learned as healthcare epidemiologist in these fourteen years.

1. Careers in healthcare epidemiology can take many different trajectories. Mine was characterized by 1. A massive regulatory survey failure of our healthcare system, which needed aggressive improvements in infection control for two years followed by heightened vigilance for another five years, 2. A system-wide program enabled by the Texas 1115 waiver mechanism, to reduce healthcare-associated infections and sepsis mortality, 3. Infection control programs becoming part of quality departments, increasing popularity of bundles of care and socioadaptive approaches, and 4. Value-based purchasing and other federal financial programs that our infection control program was held accountable for. There were other things like Ebola in town and the rising popularity of mandatory influenza vaccination for healthcare personnel.

2. Not just outbreaks or infection trends – everything in life and work is a function of time, place and person. Then there is the how and why. Management coaches teach you to ask the ‘why’ using any word other than the word ‘why’ because it was associated with attracting negative emotions. In science, everything revolves around ‘why.’ Then there are exposures, outcomes, confounding factors, effect modifiers and interaction terms.

3. We have the denominator curse upon us. There is an adage that anyone can design a numerator, but you need an epidemiologist to design the denominator. That said, invoking denominator does not help in high stakes situations which sometimes are N of one, e.g., accreditation failure, sentinel or never events. It took me a few years to get wiser about when not to bring up the denominator.  

4. We have an unconventional job title per current healthcare industry standards, which makes it hard to explain what we do to those who are not familiar with healthcare epidemiology as an area of medicine. More thoughts in this piece.  

5. Every outbreak is a combination of three outbreaks – of disease, fear, and politics. It is vital to address all three of them and manage successfully. Our outbreak investigation skills can be used for other safety events or outcomes, e.g., surgical complications that are non-infectious, medication errors. I am grateful for the training and practice I have had with outbreak investigation and control methods. I have also received weird looks for proposing outbreak investigation and control methods for an increase in non-infectious events.

6. The ‘integration’ of infection control with quality and safety departments that happened 10-15 ago in many hospitals and health systems was associated with too many turf issues. My angst described here. Add to this, academic turf issues and a certain “hierarchy of smarts” that is typical in academia.

7. Talking of politics, my own political awakening occurred when our health system failed a critical regulatory survey. We worked very hard to turn the ship around. While the SHEA-APIC Public Policy award helped tremendously, the peak of my political education thus far might be the Power and Politics course that I just finished this summer as part of my MBA program. Our professor made us internalize that we need power to get anything done. Most of us have a negative image of politics, but all the ‘people navigation’ that we have been doing to get things done constitutes politics. We just need to let go of the negative connotations for the words power and politics. Of the eight types of power described in this video, most of us have expert and information power. We can learn how to gain other sources of power. Apparently, we need it even for seemingly small things like making a child eat breakfast. Influence= Persuasion = Power = Leadership. Healthcare epidemiologists have a lot more power than we think.

8. Several skills that make someone a successful healthcare epidemiologist, i.e., clinical knowledge and skills, data skills, outbreak investigation and control methods, change management and leadership skills with respect to reducing healthcare-associated infections and improving patient safety, are relevant and applicable in healthcare delivery improvement. We have a large role to play in improving healthcare delivery.

9. Conflict is an integral part of the work we do. From getting our colleagues to practice hand hygiene to taking responsibility for organizational value-based purchasing outcomes and averting penalties to ensuring that our patients have successful clinical outcomes and that our own academic aspirations are fulfilled, we navigate a lot of conflict.

10. There is never a dull moment as a healthcare epidemiologist. There are pathogen exposures of many varieties (two of my favorites – bat flying through a hospital unit, got stuck by a nail while removing beef tongue nailed to a tree), a million reasons why hand hygiene was not performed (“the person telling me to do it is not a doctor”), and so many countries and cultures and lifestyles to learn about for emerging pathogens exposures (one of my favorites was a delirious patient who was a private airplane pilot and uttered the words Sierra Leone when the flight path records showed no travel through that area – the patient was diagnosed with cerebral malaria).

I am going to miss healthcare epi work as I try my hand at something else to change it up a bit!