The Ebola effect: HCWs working in teams could protect co-workers, patients from other infections
It’s hard to write “silver lining” and “Ebola” in the same sentence, but something powerfully good could come out of the horrific outbreak: a new safety culture in U.S. hospitals that better protects healthcare workers and patients. But it won’t be easy.
The entrenched hierarchical culture that still prevails in healthcare was imploded as step one by the highly successful Ebola response teams. Instead, clinicians formed teams of equals, essentially systematized every step of patient care and occupational health, and practiced transparency by removing traditional barriers to open dialogue during clinical care. Applying approaches used in the care of the 10 Ebola patients treated in the U.S. would cause some culture shock, as healthcare workers were empowered to speak up about a breach or oversight that may endanger other healthcare workers or the patient.
“There’s no hierarchy. You were not only allowed to, but expected to go up to anybody else and say, ‘The back of your gown isn’t taped,’ or, ‘I saw you accidently touching your visor,’” said Philip Smith, MD, medical director of the Nebraska Medicine Biocontainment Unit in Omaha. “It was a classless society, and that’s the only way we could get it done and achieve maximal safety.”
Smith participated in an opening panel session on Ebola recently in Nashville at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). He was asked how this “level playing field” culture was established and maintained.
“We really put a premium on it,” Smith said in the panel discussion. “We did it in our drills and in real life. Basically, if somebody came up to me and said, ‘I made a suggestion to Dr. X and they didn’t like it,’ Dr. X was not invited back. It [extends to] leadership, too — they loved to catch us. I would say ‘thank you.’ And at our next team meeting I would stand up and say, ‘thank you [again], you may have saved my life.’”
One of only four medical biocontainment units in the country, the Nebraska unit has a staff of volunteers that continuously train to prepare for any and all emerging infections and bioterror agents.
But could such attention to detail — such equanimity among doctors and nurses, for example — be applied to day-to-day infection control? Some of the volunteers in the Ebola care unit took their team’s mindset back to their regular jobs at the University of Nebraska Medical Center, but found a very different reaction from co-workers.
“They went back to their normal floors and when they found someone not washing their hands or changing a dressing without gloves, they mentioned this to them,” Smith said. “The person would not say thank you — they would growl at them. This in a way caused more frustrations. This is something we have to do and it is something that we can do: Insist on a level playing field.”
It’s hard to write “silver lining” and “Ebola” in the same sentence, but something powerfully good could come out of the horrific outbreak: a new safety culture in U.S. hospitals that better protects healthcare workers and patients.
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