Improved decision-making skills vital to avoid spread of Covid-19 in healthcare facilities

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.”

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.”

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.”