Abstract
response to commentary
Dear Editor
We thank Dr Hung and colleagues for their interest in our work. As they note, there are numerous implementation strategies and methods for leveraging improvements in clinical care. The four E’s framework is one helpful way for planning implementation, and the five key points they note are integral to our multimodal strategy.
They note that compliance and enthusiasm are critical – indeed, compliance was the main focus of the Clean Cut programme. The challenge is not whether it is critical, it is how to consistently achieve compliance with best practices and maintain enthusiasm for such work. Clean Cut helps perioperative teams identify opportunities for individual behaviour and facility process improvements through structured phases of baseline data assessment coupled with a process mapping exercise. Teams are therefore able to accurately identify specific gaps in care processes that lead to inadequate compliance with core perioperative infection prevention standards. Once gaps are enumerated, teams can prioritize and select areas they want to address first. This process promotes “buy in” from key personnel across multiple disciplines of surgery, anaesthesia, nursing, and pharmacy, as well as administration, sterile processing and cleaning personnel. It leverages the team’s collective knowledge and efforts, focusing attention on concrete actions for improvement. When there is resistance, which is inevitable, the team can present a unified front so that no single person has the burden of being the sole agent of change.
High quality data coupled with feedback is critical but not sufficient for success. Team engagement through the process of mapping perioperative practices and a commitment to iterative improvements in care are essential to Clean Cut: it helps promote not only the enthusiasm of a team’s collective efforts to improve surgical safety, but also team unity and professional satisfaction.
Disclosures: The original study was supported in part by a grant from the GE Foundation. J.A.F. was, and N.S. and N.G are Lifebox Safe Surgery Fellows; N.S. was supported by NIH T32 training grant DK007573 and is currently an NIH Fogarty Fellow; T.N. is the Global Clinical Director and T.G.W is Consulting Medical Officer for Lifebox.
Contributor Information
Jared A Forrester, Department of Surgery, Stanford University, Stanford, California, USA; Lifebox UK/USA/Ethiopia.
Nichole Starr, Lifebox UK/USA/Ethiopia; Department of Surgery, University of California San Francisco, San Francisco, California, USA.
Natnael Gebeyehu, Lifebox UK/USA/Ethiopia; Quality Improvement Department, St Peter’s Specialized Hospital, Addis Ababa, Ethiopia.
Tihitena Negussie, Lifebox UK/USA/Ethiopia; Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Thomas G Weiser, Department of Surgery, Stanford University, Stanford, California, USA; Lifebox UK/USA/Ethiopia; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.