Murphy Denise M
Infection Control & Healthcare Epidemiology Consortium, BJC HealthCare, St Louis, MO 63110, USA.
Am J Infect Control. 2002 Apr;30(2):120-32. doi: 10.1067/mic.2002.120526.
The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC), published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled "Breaking Out of the Box," Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations "re-engineer" more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business.
当前的经济和政治环境给美国的医疗保健机构带来了挑战，要求它们提供价格合理、可及且全面的医疗服务。然而，医疗保健提供者报销政策的变化会影响其提供前沿服务同时降低成本的能力。因此，各机构正在进行重组、重新设计、合理规模调整、精简规模和重新规划，所有这些都是为了省钱，同时也希望保持质量和客户服务方面的声誉。维姬·弗雷泽博士在2000年APIC会议的主题演讲中提醒我们，医院感染控制与流行病学（ICHE）项目是成本中心而非收入来源，并且常常成为预算削减的目标。尽管1985年发表的哈利医院感染控制效果研究（SENIC）是一个具有里程碑意义的事件，证明了我们这个职业使命的重要性，但它正逐渐过时。感染控制专业人员（ICP）必须继续哈利的工作，找到创新方法向医疗保健管理人员推销或展示ICHE项目的价值。杰克逊和马萨纳里在1999年APIC会议的一个题为“突破常规”的研讨会上致闭幕词时，向ICP提出挑战，要求他们了解不断变化的医疗保健环境，积极主动，并建设性地帮助各机构更高效地“重新设计”，而不是觉得自己是受害者，无助地等待被重新设计到不复存在。精简规模的威胁促使BJC医疗保健公司的ICP意识到，是时候改变他们自己的文化和态度，并专注于感染控制业务了。这一变化需要挑战单人从业者、数据收集者以及感染控制数据和知识守护者的传统角色。现在的目标包括领导致力于降低医疗保健相关感染的干预团队，在降低感染率方面进行合作而非独自承担责任，以及学会在没有职权的情况下施加影响。持续关注质量和成本效益，并展示临床结果的改善成为了一项承诺。本文讨论了BJC医疗保健公司的变革历程，以便为任何寻求可能使他们继续运营的必要变革策略的环境中的ICP提供有用的信息和工具。
