Improved decision-making skills vital to avoid spread of Covid-19 in healthcare facilities
New research from Halmstad University investigates the prevention of healthcare associated infections and gives a clue on how to avoid the spread of for instance Covid-19 in hospital settings. PhD student Luís Fernando Irgang dos Santos points out healthcare professionals’ decision-making skills as key to limiting infection outbreaks.
”Why are these infections so common and how can they spread in an environment that ought to be safe?”
Luís Fernando Irgang dos Santos
Healthcare associated infections – infections that patients acquire while receiving care for other conditions – affect millions of patients world-wide and cause hundreds of thousands of deaths each year. PhD student Luís Fernando Irgang dos Santos first came across the issue when working with hospital management in his home country of Brazil.
“Healthcare associated infections are a big issue, especially in countries with developing economies such as Brazil. I was working in the administrative staff at a hospital and got to see the problem firsthand. Then and there I started asking myself what was wrong. Why are these infections so common and how can they spread in an environment that ought to be safe?”, says Luís Fernando Irgang dos Santos, continuing:
“When comparing developing countries with developed ones, such as Sweden, I have found several differences in how infections are detected and handled in healthcare environments. There are discrepancies in management and implementation of procedures and guidelines as well as in practice.”
Multi-disciplinary teams key to success
Infection prevention and control teams are responsible for keeping healthcare associated infections at bay. The teams are multi-disciplinary, consisting mainly of nurses and doctors with an expertise in infection prevention and control. In larger healthcare facilities, management and administrators might also be part of the teams.
“The members of the infection prevention and control teams are key players in detecting and preventing healthcare associated infections. Through my research I hope to contribute to their very important work by investigating what skills a well working team needs to develop”, says Luís Fernando Irgang dos Santos.
To achieve successful infection prevention and control it is important for the teams to separate the prevention stage from the control stage of a possible infection outbreak.
“I have identified two different modes of decision-making, each consisting of separate sets of practices ideal for either prevention or control, but not for both. The infection prevention and control teams have to know how and when to switch between these two skills sets, and to do so, they need to be able to correctly identify which stage a possible infection outbreak is at”, Luís Fernando Irgang dos Santos explains and proposes a practice that can help the infection prevention and control teams to make the right decisions at the right time.
“It is vital that the team makes the correct assessments and prioritisations early on in the process. If they decide to treat an infection as a possible outbreak too soon, they might end up wasting time and money on something that could have been just one isolated case. However, if they don’t react fast enough, they risk widespread infections. Because of this, it is important that the infection prevention and control professionals identify the characteristics and the nature of the issue at hand and make grounded decisions based on facts.”
Follow the problem
By focusing on the infection and its’ unique characteristics, it is possible to make the correct decisions and contain a possible outbreak. This might seem obvious, but according to Luís Fernando Irgang dos Santos, focus often lies on other aspects:
“In my approach, the problem – rather than the decision-making or the resources available – is the unit of analysis. By following the problem and identifying what decision-making mode is needed in each stage of the process, infection prevention and control teams can gain new understanding and make the correct decisions in order to avoid healthcare associated infection outbreaks.”
”It is vital that the team makes the correct assessments and prioritisations early on in the process. If they decide to treat an infection as a possible outbreak too soon, they might end up wasting time and money on something that could have been just one isolated case. However, if they don’t react fast enough, they risk widespread infections.”
Luís Fernando Irgang dos Santos
Luís Fernando Irgang dos Santos bases his recommendations on theories stemming from organisational learning – the process of creating, retaining and transferring knowledge within an organisation.
“It is not enough to lean on instinct when it comes to these matters. The infection preventionists have to acquire decision-making skills from somewhere, and in order to do so, healthcare institutions need to facilitate organisational learning. This can be a problem, especially in smaller hospitals where the infection prevention and control teams tend to be less structured, and where management is not always part of the teams.
Covid-19 – a game changer
Luís Fernando Irgang dos Santos had just reached the halfway-mark in his research when the first cases of Covid-19 started to appear. From one day to another, circumstances had changed. The world was faced with a fast-spreading virus and what would soon become a pandemic. Healthcare facilities were suddenly overloaded with work. Patients were pouring in and nobody knew quite how the situation would unfold itself. To Luís Fernando Irgang dos Santos this posed a problem, as healthcare institutions no longer had the time or the possibility to participate in his research. Eventually, though, it also came to open up new opportunities.
“When I started my research, the plan was to develop a model that can be used by infection prevention and control teams in order to facilitate switching between the different modes of decision-making. I am still determined to present such a model, but I have had to put it on hold due to the pandemic. Instead, the second paper of my licentiate thesis investigates how infection prevention and control teams in different healthcare institutions in Brazil implement the recommendations issued by the World Health Organization, and what the consequences are when the recommendations are not implemented alike by all teams”, says Luís Fernando Irgang dos Santos, who has identified both cognitive and emotional aspects that influence the way in which the recommendations are implemented:
“Infection prevention and control teams have an important role in controlling the emotional environment in which they work. If they are not successful in doing so, they will encounter problems when it comes to implementing recommendations in situations like the present pandemic. I have identified three different aspects which are important when it comes to the control of emotions; authority, safety and organisational change. Firstly, the infection preventionists need to be credible, to have authority. Support from the management is vital, and the people who work in the infection prevention and control teams need to have their coworkers’ trust. Secondly, the employees have to feel safe at work. They have to trust that they will be safe if they follow the instructions from the infection preventionists. Thirdly, the infection prevention and control teams have to create organisational change in a way that creates flexible organisations. The coworkers have to be prepared for conditions to change, and they have to trust in management to have their best interests at heart.”
About the thesis
The thesis was presented at Halmstad University on September 15, 2020.
Differences between developed and developing countries
Luís Fernando Irgang dos Santos has conducted a large part of his research in Brazil. One of his goals is to compare the strategies of infection prevention and control teams in developing countries, for instance Brazil, to those of their counterparts in developed countries, for instance Sweden.
“I have found significant differences in the decision-making skills and strategies between Brazilian and Swedish infection prevention and control teams. The Swedish teams are far superior in switching between the prevention mode and the control mode at the right time, resulting in them being more successful in containing outbreaks of healthcare associated infections”, says Luís Fernando Irgang dos Santos, continuing:
“The differences in decision-making and how well the teams are able to switch between the two modes can have a number of different reasons. One important factor is cultural differences. In Brazil, the government has not been able to establish a feeling of safety and trust. The healthcare professionals have not felt safe during the Covid-19 pandemic, nor have the people. Instead, fake news has caused insecurity, and the number of people who don’t believe there is a pandemic is significant. In the light of the Brazilian president Bolsonaro’s sometimes rather peculiar statements, it is no wonder that people – including the infection prevention and control teams – don’t know how to handle the ongoing situation. In Sweden, the situation is quite different. The Swedish government and the Public Health Agency of Sweden base their decisions and recommendations on science, and this builds trust.”
On March 13, 2017, an international academic agreement for double degrees in the third level of education was agreed upon by Regional University of Blumenau – FURB, Brazil, and Halmstad University, Sweden. The agreement aims to strengthen the ties between Brazil and Sweden through the production of academic research that generates knowledge in the field of Innovation Sciences and whose results contribute to the development of both countries in areas such as Health Innovation, Industrial Management and International Marketing. Through this collaboration, students from both universities have the opportunity to complete part of their studies at the partner university, participating in academic projects and developing their licentiate or doctoral thesis under the guidance of supervisors from both universities.
The first student to complete his studies from the double degree programme was PhD Henrique Correa da Cunha, who defended his doctoral thesis in 2019. Luís Fernando Irgang dos Santos joined the double degree programme in January 2019 and finished his licentiate thesis in September 2020. PhD student Manoella Antonietta Ramos da Silva, who also joined the double degree programme in 2019, is expected to finish her licentiate thesis in December 2020.
Developing a model the next step
As Luís Fernando Irgang dos Santos defends his licentiate thesis, he is now halfway through his journey towards the PhD degree. The next step in his research is to investigate digitalisation in healthcare in connection to healthcare associated infections. He also hopes to be able to develop a model that can help healthcare practitioners, both on a team level and on a national and international level, to implement his findings.
“Some of the results that I present could be applicable on both a national and an international level as they address the process of implementing new solutions in order to prevent infection outbreaks. I hope that my research will benefit society. That is my ultimate goal – I want to make the world a better place!”, Luís Fernando Irgang dos Santos concludes.
Text: Christa Amnell
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