IP&C Programs:
Prioritize + Organize = Maximize
TSICP
31st Educational Conference
Patti Grant, RN, BSN, MS, CIC
ICP: Medical City Dallas Hospital
[email protected]
OBJECTIVES
• List 3 Essentials of an ICP Program
• Discuss “The 7 Habits” Tools
– Circle of Influence vs. Circle of Concern
– 4 Quadrants of the Time Management Matrix
• State Maximizing IP&C Program Tactics
– One Organizational Approach
– One Prioritization Approach
TSICP -- 03.28.08 P.GRant
Essentials for IP&C Success
•
•
•
•
Hardware: An excellent PC
Access to the internet (da)
IC Software Program?
Educational Conferences Off-Site
– Lessons Isolation and “Depression”
– Face to Face Networking -- Valuable
• Medical Library Options
– PubMed – Budget to download articles
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
– Contract with University Library Services
TSICP -- 03.28.08 P.GRant
Essentials for IP&C Success
• Member of APIC? TSICP? ( www.TSICP.org )
• References
–
–
–
–
American Journal of Infection Control
Hospital Infection Control & Epidemiology
APIC Text
MMWR (on-Line and free)
• Join Listserve’s
– Hand-Out (on-line and free)
• Favorites -- Bookmark URL Sites
– Hand-Out (just ones I use)
TSICP -- 03.28.08 P.GRant
On-Line Statistical Packages
• CDC’s Epi Info (free download & FAQ)
– http://www.cdc.gov/epiinfo/downloads.htm
– http://www.cdc.gov/epiinfo/Epi6/ei6faq.htm
• Simple Interactive Statistical Analysis (SISA)
– http://home.clara.net/sisa/
TSICP -- 03.28.08 P.GRant
Let’s Say You Have the Essentials …
HOW DO YOU HAVE TIME
TO PLAY WITH YOUR TOYS?
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370 Pages of WOW … With Index
• Circle of Influence
Vs.
Circle of Concern
• Time Management
Matrix: 4 Quadrants
TSICP -- 03.28.08 P.GRant
You Can Decide How To Use Time
• Covey Says Some of Us “Blame Others”
• DETERMINISM
– Genetic: My Grandparents Did This To Me
– Psychic: My Parents Did This To Me
– Environmental: My Boss Does This To Me
• Do You Let “Others” Determine Your Time
Management Priorities? Your Responses?
TSICP -- 03.28.08 P.GRant
Simply Stated: We Can Choose
REACTIVE MODEL

CHOICE:
This is YOU
Stimulus
Response

• Ventilator Days not ready (Again) … Report Due
• Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
• Suspect a Cluster of MR-Acinetobacter in ICU
• E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
CORNERSTONES
• Between Stimulus & Response,
man has the right (power and
freedom) to choose
• It is not what happens to us, but
our response to what happens to
us that hurts us.
TSICP -- 03.28.08 P.GRant
Our Response Dictates Time Spent
• Circle of Influence
– Can do something about this directly
– Centered Around a Proactive Response
• Circle of Concern
– No real direct control over these issues,
although you are very concerned about them
• Centered Around a Reactive Response
vs.
• Not much of a sustained response at all?
TSICP -- 03.28.08 P.GRant
Concentrate Time To Be Reality Driven
Influence = Proactively
Circle of Influence
Circle Of Concern
Concern = Determinism (Reactive)
TSICP -- 03.28.08 P.GRant
Influence or Control?
Thoughts Drive Your Effectiveness*
REACTIVE LANGUAGE
PROACTIVE LANGUAGE
There’s Nothing I can do
Let’s Look at our alternatives
That’s just the way I am
I can choose a different approach
He makes me so mad
I control my own feelings
They won’t allow that
I can create an effective
presentation
I have to do that
I will choose an appropriate
response
I can’t
I choose
I must
I prefer
If only
I will
TSICP -- 03.28.08 P.GRant
* 7 Habits: Page 78
At the
of the ICP’s Role
• How Much Control Do We Really Have?
– Very Little
– Too Often no ‘Formal Power’ … But …
– Lots of ‘Responsibility’ for Outcomes (?!)
• GOAL: Act  Proactively React
Move Issues from Your Circle of
Concern into Your Circle of
Influence
TSICP -- 03.28.08 P.GRant
Time Management History
• 1st: Notes & Checklists
• 2nd: Calendars and Appointment Books
• 3rd: Prioritization, Values Clarified,
Comparing Values to Determine
Goals and Where Spend Time
• 4th: Covey … Don’t Manage Time …
Instead Manage Yourself
-- Expand Circle of Influence
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CONSEQUENCES
Freedom & Power to Choose
Circle Of Influence
(Your Response)
Circle of Concern
(Others Reactions Can’t Control)
TSICP -- 03.28.08 P.GRant
Manage Yourself – Your Choice
• Determinism – React with Helplessness
– CIRCLE OF CONCERN
Vs.
• Proactive – React with Purpose
– CIRCLE OF INFLUENCE
• Time Management Matrix
– Four Quadrants – Where Do You Live?
TSICP -- 03.28.08 P.GRant
Time Management Matrix
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Living in Quadrant I ?
• Urgent & Important
– If don’t get this under control … can become
90% of time spent … No time for planning …
– Live in the “Put Out Fire” Mode
– No time to give justice to unexpected crisis
– Low quality of work satisfaction
• What Are Your Daily Quadrant I Activities?
– On A Daily Basis?
– From The List We’re Working On?
TSICP -- 03.28.08 P.GRant
Which Belongs in Your Quadrant I ?
• Urgent & Important
– Ventilator Days not ready (Again) … Report Due
– Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
– Suspect a Cluster of MR-Acinetobacter in ICU
– E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
Living In Quadrant II ?
• Not Urgent & Important
– All those things we know we need to do, but rarely get
around to doing, because not ‘urgent’ (at this
particular date and time)
– Where we need to be to decrease time spent in
Quadrant I
• Planning, Relationship Building, Posters, Publishing, etc.
• What Are Your Daily Quadrant II Activities?
– On A Daily Basis?
– From The List We’re Working On ?
TSICP -- 03.28.08 P.GRant
Belongs In Your Quadrant II ?
• Not Urgent & Important
– Ventilator Days not ready (Again) … Report Due
– Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
– Suspect a Cluster of MR-Acinetobacter in ICU
– E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
Living In Quadrant III ?
• Urgent & Not Important
– Most time spent reacting to others
– “Treat” issue as important when it is not
– Urgency of issues often based on the
priorities and expectations of others
• Your Daily Quadrant III Activities?
– On A Daily Basis ?
– From The List We’re Working On?
TSICP -- 03.28.08 P.GRant
Belongs In Your Quadrant III ?
• Urgent and Not Important
– Ventilator Days not ready (Again) … Report Due
– Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
– Suspect a Cluster of MR-Acinetobacter in ICU
– E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
Living in Quadrant IV ?
• Not Urgent & Not Important
– If not careful, Quadrant I becomes 90% of
your life … and you escape here!
– “Busy Work” vs. “Productive Work”
– Gossip, Time Wasters, Obsolete Routines
• Your Daily Quadrant IV Activities?
– On A Daily Basis ?
– From The List We’re Working On?
TSICP -- 03.28.08 P.GRant
Belongs In Your Quadrant IV ?
• Not Urgent & Not Important
– Ventilator Days not ready (Again) … Report Due
– Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
– Suspect a Cluster of MR-Acinetobacter in ICU
– E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
Live In Quadrant II Daily
• Move Items “living” in less pressing quadrants
into Quadrant II:
– Quadrant III: Urgent & Not Important
– Quadrant IV: Not Urgent & Not Important
• Live More In Quadrant II:
– Prevention Activities (Team Member for IHI Bundles)
– Build Relationships (Emotional Deposit Bank)
– Realizing New Activities
• Posters, Presentations, Publications
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REAL LIFE ICP APPLICATIONS
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• Remember the CMS Job Add-On ?
• “Just One More Thing” Strategy
– Get on O-Team’s Agenda
• Present bare minimum Surveillance Done for
JCAHO, OSHA, Health Dept, CMS, Public HAI
Reporting, etc. …
• Then ask THEM to decide what you’ll STOP doing
to take on added non-IC&P Task
• Take it all the way to the Governing Board
TSICP -- 03.28.08 P.GRant
Daily Drudgeries ?
• Get These Under Control  GONE from
Quadrant I forever !!!
• Site Visits, Quarterly Reports w/monthly look
• Communicable Disease Reporting
• Reviewing Micro Reports, Review P&P, etc.?
• Reports due to YOU and by YOU to Others?
– Make a schedule
– Get it Organized & Stick To It
– Send ‘friendly reminder’ e-mails
TSICP -- 03.28.08 P.GRant
Quadrant II  Daily Progress
• How Can You Build Relationships
– Without Meetings?
– Without Excessive Time Spent?
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A Daily “Self-Fulfilling Prophecy”
• Act The Part Of “Indispensable”
–
–
–
–
Proactive IP&C Expert
Patient Safety Advocate
Biological Employee Safety Expert …
What Can You Offer That They Don’t Know They
Need? … Not Always $$ … Can Be Processes Too
• Act The Part of the Reactive
Helpless Victim?
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Own Your Professionalism
CIC
www.cbic.org
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Decreasing the “Hassle Factor” …
…. Directly
Increases the
“Quality of Work"
Factor
TSICP -- 03.28.08 P.GRant
Communication Patterns
• Join Listserve’s …
– Be First To Know “Stuff”
– Broadcast E-Mail to All-Users
– Include as Announcement of IC&P Agenda
• IP&C Advisory Group Meetings
– Provide Inservices
– Share Detailed Information
• SARS, Avian Flu, Anthrax, TB, Hepatitis
• Surveillance Activities, Site-Visits
• Scavenger Hunts, Contests, Hand-Hygiene
Observations
TSICP -- 03.28.08 P.GRant
Virtual Meetings
• Works well with “Turf War” Topics
• ICP is the “Facilitator”
– Initial F2F Meeting for Purpose & End Result
– E-Mail: Ask Series of Questions
– E-Mail: Share Back Responses in an
anonymous Table Format
– E-Mail: Clarify and Repeat as Needed
• 2nd (last?!) F2F Meeting to Clarify/Finalize
– Disseminate End Result
TSICP -- 03.28.08 P.GRant
Routine Q&A … The Infection
Prevention & Control Consult *
• A Question is a CONSULTATION
• Follow-Up all questions w/in 24 hours
• Document all consultations
– Follow-up all questions in writing (e-mail)
• Anticipate Additional Questions and Provide Answer
– Make a “non-confidential” version and share quarterly
as a formal report
• Documents Interdisciplinary PROBLEM-SOLVING
* Grant PS & Kim AT; Am J Infect Control 2007;35;401-6
TSICP -- 03.28.08 P.GRant
Miscellaneous Goodies
• Vendors: Schedule same day/time …
Don’t waver from that  EVER
• DAILY: Schedule at least 1 hour ‘down
time’ to handle emergencies (even if Q 3)
• Get a “Routine” for boring stuff that can
build up into a problem
– ↓es panic, feelings of chaos, and drowning
• Promote SELF: ↑ Visibility = ↓ed Surprises
TSICP -- 03.28.08 P.GRant
PROGRESS IS PROGRESS
We cannot do
EVERYTHING at once, but
we can do
SOMETHING at once
-- Calvin Coolidge
… Am I being purposeful in
progress ?!
TSICP -- 03.28.08 P.GRant
Quadrant Wise:
So What Do You Think?
– Ventilator Days not ready (Again) … Report Due
– Told You Are Now Doing the CMS Abstracting Core
Measures (SCIP & Vaccines)
– Suspect a Cluster of MR-Acinetobacter in ICU
– E/D Called … They Suspect Meningococcal Disease
TSICP -- 03.28.08 P.GRant
III
TSICP -- 03.28.08 P.GRant
SUMMARY
• List 3 Essentials for an
effective IP&C Program
• Discuss “7 Habits” Tools
– Circle of Influence
vs.
Circle of Concern
– 4Q Time Management Matrix
• State Maximizing IP&C
Tactics (Organizational &
Prioritization Approach)
TSICP -- 03.28.08 P.GRant
Q & A SESSION
TSICP -- 03.28.08 P.GRant