How collaboration in healthcare reduces HACs

Goals and quality initiatives often focus on preventing healthcare-associated infections and pressure injuries. You look at your protocols, processes and products. But how often do you focus on interprofessional collaboration in healthcare? This article explores the key elements of collaboration, benefits of collaborative practices, and challenges and solutions to successful collaboration that can help reduce HAIs and PIs.

What does interprofessional collaboration in healthcare look like?

“A collaborative culture of prevention thrives on mutual respect, trust and open communication,” says Janina-Marie “Nina” Huss, MBA, FAPIC, CIC, LTC-CIP, infection prevention officer at WVU Medicine in West Virginia.

“It means sharing a goal of patient safety and improved outcomes through reducing variabilities,” adds Angela Newman, MBA-HM, BSN, RN, CCRN, VA-BC, market solutions expert at Medline.

In addition, it’s essential to have all the players at the table. “You have to be open, create that safe space and have respect,” says Donna Matocha, DNP, MSN, RN, CNRN, VA-BC, clinical resources specialist at Medline.

Collaboration reduces healthcare-associated conditions

Collaboration allows teams to quickly identify patterns or emerging threats and develop more effective protocols. In fact, research has found that forming interdisciplinary collaborations in intenstive care units led to a 25% reduction in MRSA infections, while a routine of interdisciplinary daily team huddles resulted in a 20% decrease in HAIs. The collaborative culture was also shown to improve hand hygiene compliance and faster response to infection outbreaks in long-term care facilities.¹

20% fewer
HAIs with collaboration¹

25% reduction
in MRSA infections¹

“By working together, teams can catch potential issues early, monitor patient progress and adjust treatments accordingly, leading to more timely interventions,” Huss explains.

“When you have collaboration on the front end, you can create a growth mindset and look for opportunities for improvement, instead of having to do a root cause analysis on why a never event happened,” Huss says, adding that this collaboration can and should include patients, their visitors and other external sources that are involved in continued care. “There’s this space where everyone shares knowledge for the better outcomes of the patient.”

“When you have collaboration on the front end, you can create a growth mindset and look for opportunities for improvement, instead of having to do a root cause analysis on why a never event happened.”—Nina Huss, MBA, FAPIC, CIC, LTC-CIP, Infection Prevention Officer at WVU Medicine

Identifying a goal of no harm is great, but everyone has to share that goal. “If it’s one horse pulling the carriage, and the others are just standing there, you’re never going to get to zero harm,” Newman says.

Two keys to effective collaboration

Communication and trust are the keys to building interprofessional collaboration in healthcare. Think of an example of when you’ve trialed a new product. If leadership is less than transparent about what the success metrics are for the product, then the frontline staff may feel like they’re given something they like, only to have it taken away without their input or knowledge of why. When leadership communicates what’s working and where there are gaps, it builds trust among and between units. “Not communicating that out really fosters lack of trust,” Newman notes.

“Trust is a big piece of all of this,” Huss notes. “If an organization or a leader has lost trust, how do you get this collabora-tion?” To build that trust, leaders need to focus on nurturing a place of psycho-logical safety, “making sure you have a no-blame mindset and culture within your organization,” Huss says. But breakdowns in psychological safety often stem from a fear of retaliation or judgment.

“A lot of times you’ll see leaders speak-ing to a group and everyone is just nod-ding and saying, ‘mhm, mhm.’ They’re not going to share their point of view if they’re afraid,” Huss says. If the speaker is simply telling the team what is going to happen, it doesn’t give team members any safe space to offer other considerations. “They may be in the meeting nodding and in their head, they’re thinking, ‘This is never going to happen,’” Huss says. But if there’s no trust, they won’t share concerns, and you’ll never know they’re actually not going to do what you’re telling them to do.

Other times, a team member may fear for their job if they share their knowl-edge. “Maybe they think layoffs are coming or there’s a reason they need to harbor information so they can be needed for a project instead of collaborating,” Huss explains.

“I know it sounds so cliché, but collaboration is a ‘We’re all in this together type of approach, and we can learn from each other,’” Newman comments. “Then anyone should feel free to speak up. But I think it ultimately boils down to the culture.”

How to gain trust through 3 essential strategies

Developing trust among your team does not happen overnight. It’s a constant investment in time and attitude. There are several ways to bank that trust:

1. Take the blame out of mistakes. Studies have shown that creating an organizational culture of accountability normalized the likelihood that a frontline nurse would speak up with concerns or questions.² Feeling accountable as part of collaboration means that any missteps are viewed in the context of the organizational protocols and not attributed solely to an individual.

2. Make informal interactions meaningful. Including all levels and types of team members in committees and meetings helps instill a feeling of inclusion and collaboration. However, just as important are the informal interactions that happen without a manager’s control.

“A lot of times these teams only work together when they have to,” Newman points out. That’s when loosely facilitated ad hoc encounters help break down silos and encourage knowledge sharing.² You might try:

• Locating offices in close proximity, encouraging passing conversations
• Overlapping time on lunch breaks
• Starting meetings a few minutes late or ending a few minutes early
• Combining break rooms among multi-ple professions
• Putting physician work stations near nursing stations
• Spending a day with a different team on a regular basis

“I think it’s about being open to conver-sations, open to learning from others and finding ways to have that dialogue,” Newman says. At a recent conference of chief nursing officers, Newman talked to one nurse leader who brings coffee to dif-ferent units. “And she advertises it; she’ll host at times where day shift or night shift can come, and she’ll say, ‘Just tell me what’s on your mind.’”

Informal conversations like these can help team members learn about each other, what they’re working on, where they can help each other. “You get a different per-spective. You get a better understanding of what’s actually happening on the frontline.”

3. Seek leadership education.“We have this tendency to say we have to educate the nurses,” Matocha says. “And it’s so much bigger than that.” For example, start with communication courses because communication is so integral to a success-ful collaborative culture. If this kind of behavior and attitude doesn’t come easily, consider coaching classes.

“We want to set examples and be role models,” Huss says. “But taking some of those coaching classes, making sure you understand active listening, can really help.”

At the CNO conference, Newman says she heard many participants express a similar theme: “How come I’m trying to do 12 hours worth of work in 8 hours every day?” But she stresses that learning and collaboration are valuable. “Leaders need to be aware that even just a little bit can make such a difference.”

Break down hierarchical structures and silos

Building on the trust and communication solutions, it’s important to start thinking of everyone having an important role in the microsystem of a collaborative culture. “Leadership can feel on this pedestal for frontline staff, people they don’t see or reach,” Newman says. “So bringing everyone together, having CNOs rounding on units, talking to staff, having staff liaisons as part of committees. I think that’s really how you start to create the culture and continue to drive it.”

Sometimes, instead of soliciting feed-back from frontline staff, leadership may assume what they’re thinking, feeling or experiencing. “If you just take the time and actively listen to it, it’s so powerful,” Newman stresses.

You might call it “shared governance,” Matocha says. “The end user, the person at the bedside who’s seeing the problems is coming up with the solutions, which ultimately is going to drive the success that gets shared with the director of nursing. And so, we’re trickling up in a way,” she adds.

Sometimes, instead of soliciting feedback from frontline staff, leadership may assume what they’re thinking, feeling or experiencing. “If you just take the time and actively listen to them, it’s so powerful,” Newman stresses.

You might call it “shared governance,” Matocha says. “The end user, the person at the bedside who’s seeing the problems is coming up with the solutions, which ultimately is going to drive the success that gets shared with the director of nursing. And so, we’re trickling up in a way,” she adds.

Collaboration and its relation to staff retention

“Nurses take pride in their work,” Matocha says. “They get up every day going into the hospital, saying, ‘I’m going to do a great job for my patients.’” But, she says, if they can’t or they feel like they’re going to be attacked or blamed for something, they will start to lose that passion.

“When team members don’t feel supported or valued, it can contribute to high turnover rates and dissatisfaction,” Huss agrees.

“A collaborative environment promotes shared responsibility and positive rein-forcement, which helps reduce burnout.”

Focus on interprofessional collaboration in healthcare to help reduce HAIs and PIs, as well as to increase staff satisfaction and retention. The key elements of successful collaboration rest on building communication and trust by taking blame out of the process, making informal conversation meaningful and seeking leadership education when necessary. Using a change model and keeping track of improvements help sustain the benefits of collaborative practices.

Measuring success of your collaboration efforts

Ultimately, the success of your collaboration efforts comes in the form of improved patient outcomes. Track the data through monitoring infection rates and pressure injury incidences. Track improvements in patient recovery rates or reductions in complications. Also track what Huss calls “input measures.” Also track what Huss calls “intermediate steps.” Things like increasing the use of CHG wipes as treatment that reduces HAIs.

Be sure to also measure staff experiences. “When you’re trying to create that culture where staff feel empowered, look at metrics of job satisfaction,” Newman points out. “These are the people who ultimately do the care, so getting their perception of success is really important.”

Huss suggests these 4 ways to ensure continuous improvement and sustainability of collaborative practices:

• Regular training and updates: Keep staff informed about new practices and fostering ongoing learning.
• Feedback loops: Constantly gather feedback from all team members to identify barriers and successes.
• Leadership commitment: Leaders must continually advocate for and model collaborative practices.
• Celebrating small wins: Recognize milestones and successes to foster long-term commitment to collaboration.