In this month’s post, I want to share why I am so proud of our work on this review paper and why it is important not only to healthcare epidemiologists but also to quality and safety professionals. I would like to reiterate that this post (like all other posts on my blog) represents my views. I am not speaking here on behalf of my co-authors or our professional society that sponsored the work. When Dr. Keith Kaye invited me to join the Society for Healthcare Epidemiology of America quality advisory group almost three years ago, I jumped at the chance. I have the greatest respect for him and for each and every member of the team, and the topic is near and dear to my heart.
The paper begins with an overview of the quality and patient safety movement, and important concepts, approaches, and metrics in quality and patient safety. The paper then discusses the role of the healthcare quality leader, and compares and contrasts the similarities and differences in healthcare epidemiology and quality. The last third is about where the convergence is among infection prevention, quality and patient safety lies, and closes with practical advice on how to go about determining whether quality is a “right” career path for you, and next steps for consideration. It is a nice review of concepts in quality and safety including a crosswalk between concepts and desired skills in the two overlapping fields of healthcare epidemiology, and quality and patient safety, and offers helpful career guidance. Choosing to go deeper within healthcare epidemiology versus going broader into quality and safety or any other overlapping discipline is an individual career choice and there is no “one size fits all.” I highly recommend that all my colleagues in the field of healthcare epidemiology read the paper regardless of level of interest in the field of quality and safety. Further, I would encourage my colleagues to share the paper with the quality and safety professionals and healthcare administrators in their own health systems and clinical practices. The more we understand each other’s disciplines, the better off we and the patients we serve will be.
When I began career as healthcare epidemiologist fifteen years ago, the results of the Keystone Michigan ICU project team were just published in the New England Journal of Medicine, and my new bosses tasked me with that – implement central line bundle in the ICUs! That same year, the Centers for Medicare and Medicaid Services began their financial disincentives for healthcare-associated infections and also began their public reporting of infections on Hospital Compare. Although we achieved a meaningful reduction in infection rates over the next two years, the newly established quality and safety leadership for the health system had their own ideas about how data need to be presented in executive meetings (run charts, driver diagrams, etc.) and how the bundle should have been implemented (rapid cycle improvement, plan-do-study-act, etc.). I had trained in epidemiology at a school of public health, and trained with a healthcare epidemiology program before there were quality and safety leaders above them in the chain of command. It seemed like we came from two different planets, but those were the years when infection prevention departments all over the country were being placed within the umbrella of quality and safety and being reorganized to be part of quality departments. Many medical centers concurrently expanded their healthcare epidemiology and quality programs in the last decade and the growing pains were felt by many. The quality and safety professionals were given more power in the health systems. There were plenty of colleagues within SHEA to compare notes with and learn from. Many healthcare epidemiologists including the authors on this SHEA paper embraced the change and learned to do the crosstalk. I have written quite a few blogposts that shine light on the overlap and share some angst: integrating quality, safety and infection prevention, converging quality, safety and value at the bedside, the identity crisis of a healthcare epidemiologist and reflections on fourteen years as a healthcare epidemiologist. It is little wonder that working on this paper was both meaningful and gratifying to me.
Improving infection rates and related outcomes like mortality is not at all new to the field of infection prevention, and in fact, is at the very foundation of the field. Both Semmelweis and Nightingale collected data meticulously, designed interventions and implemented them while tracking results. That being said, the origins of the quality and safety movement in manufacturing industry, with different concepts and principles laid down by Deming, Shewhart and Juran, have a role for application in reducing undesirable variation in clinical care practices and improving quality and safety. Any program establishment or enhancement and any improvement work, whether in healthcare epidemiology or in quality and safety, requires leadership. The improvement mind-set is similar in both the fields, the skills are somewhat different in the two fields, and the improvement tools are different. As anyone who has tried to improve hand hygiene can attest to, it is worthwhile to utilize multiple tools, try different levers and do whatever it takes to achieve the improvement we need. We can try out these principles on increasing mask use and vaccine uptake during this pandemic!
Reference: Sreeramoju P and Palmore TN, Lee GM, Edmond ME, Patterson JE, Sepkowitz, KA, Goldmann DA, Henderson DA, Kaye KS. Overview of Quality and Safety for the Healthcare Epidemiologist. SHEA White Paper. Infect Control Hosp Epidemiol. 2021 Jan;42(1):6-17. doi: 10.1017/ice.2020.409. Epub 2020 Sep 4. PMID: 32883390
Post-note: I learned very recently that the term “white paper” promotes implicit racial bias that white = transparency, and black = darkness, and edited the post to remove white as a descriptive word for this important paper.