1. Patients get “recommended care” ~ 50% of the time. Adverse events occur in 10% of hospital patients. –50% are preventable. –7.5% of these patients die....the gap between evidence and practice 1 NEJM 2003; 348:2635-2645 Qual Safety in Health Care 2008;17:216-223

2. Hospital-Acquired Infection –Infection rates 5-10% –1.4 million patients affected each day –USA 100,000 deaths, $6.5 billion / yr JAMA 2009;301(12):1285-1287 Lancet 2008;372(9651):1719-1720 2

3. Allegranzi B. Burden of endemic health-care-associated infection in developing countries: systematic review and meta- analysis. Lancet Dec 2010. Number of HAI studies 1995-2008 3

4. Healthcare-associated infections are 2-3 x more common in developing countries 4

5. SA Hospitals? –9.7% HAI point prevalence –28.6% in ICU Prof A Duse. SA-HISC study (unpublished) 5 Private + Public Hospitals in Gauteng

6. 1 in 7 patients who enter SA Hospitals are at risk for developing an HAI Brink A et al., SAMJ 2006; 96(7) 6

7. Delegate Survey, FIDSSA Conference Aug 20-23 2009 85.1% In the hospital(s) with which I am associated… 7

8. Why BCA? Better care, less harm Build the capacity to improve 8

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10. 10 Finding leverage and synergy to achieve sustainable, high quality health care …more quickly …at greater scale Power of leverage and synergy Leverage: doing something smart that has a much bigger impact. Synergy: two or more people produce more together than the sum of what they could have produced separately. 10

11. Why an Open Learning Session? Overcome fear The method is new (or is it?) Don’t compete on safety More ideas More fun 11

12. Why an Open Learning Session? 12

13. HAI Impact On the patient & family On you? On the hospital? Financial? 13

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16. Results…Michigan (Keystone) 66% reduction in line-related infection Saved > 1,500 lives Saved $200 million in 18 months New England Journal of Medicine. 2006; 355(26): 2725-2732 16

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18. HAI : CLABSI RATE Central Line Associated Blood Stream Infections - CLABSI 18

19. Ventilator Associated Pneumonia VAP 19

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21. VAP: Benchmarking Baptist Memorial DeSoto 21

22. Surgical Site Infections – SSI 22

23. HAI : SSI RATE 23

24. BCA : COMPLIANCE : SSI 24

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26. Making improvements Holding the gains over time Spreading results Challenges for all Nations 26

27. 27 Frontline health professionals CEOs and senior leadership 27

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33. “nobody has perfect execution anywhere in the world” Dr Brent James 33

34. “in our work, the hardest part was trying to get nurses more comfortable speaking up” Dr Peter Pronovost

35. Copyright ©2010 BMJ Publishing Group Ltd. Pronovost, P. J et al. BMJ 2010;340:c309 35

36. 36 Results…Canada Target: 50% reduction in CLI. 75% of hospitals reached national goal of <1.9 infections / 1000 catheter-days.

37. 37 Current improvement initiatives? TARGET – Sustainable, consistent, best practice 37