From national security to hospital safety: How SSM Health's chief quality officer Dr. Alexander Garza is tackling HAIs

Alexander Garza, MD, chief quality officer at St. Louis-based SSM Health, is no stranger to infectious disease prevention and response.

In 2009, former President Barack Obama nominated Dr. Garza to serve as CMO of the Department of Homeland Security at the height of the H1N1 pandemic. The virus killed an estimated 200,000 people worldwide and represents the second largest H1N1 outbreak in history behind the 1918 flu pandemic, which killed at least 50 million people, according to the CDC. While at DHS, Dr. Garza learned the importance of investing in the right resources to prevent health or safety threats — not react to them. 

Today, Dr. Garza is addressing a different threat: healthcare-associated infections. The CDC estimates about 1 in 31 hospital patients have an HAI on any given day. To reduce the prevalence of HAIs, SSM Health rolled out a care bundle approach in early 2019 with a strong emphasis on tracking performance improvement.

"We can give team members the science and say, 'This is what we know prevents HAIs,'" Dr. Garza said. "But it's also important to consider the performance improvement side and track how well we're adhering to the care bundle."

Dr. Garza talked about the new care bundle with Becker's Hospital Review and shared best practices for getting team members on board with such quality improvement initiatives. 

Editor's note: Responses have been lightly edited for style and clarity.

Question: What quality improvement goals is SSM Health focusing on this year?

Dr. Alexander Garza: There are a couple of things we're really focusing on. One is hospital-acquired infections, specifically central line-associated bloodstream infections and catheter-associated urinary tract infections. The others are sepsis, sepsis mortality and readmission reduction. We also have a couple other goals we're using as what we call "watch measures," meaning we're going to refine the data and potentially make them more systematic key performance indicators. One is opiate stewardship within the system; another is workforce injuries and violence. 

Q: How is SSM Health working to address HAIs? 

AG: We've started organizing a better systemwide approach to HAIs, as well as safety and quality overall. So that means aligning everyone who participates in these efforts, including infection prevention directors, nurses, and safety and quality personnel. The infection prevention team also built a care bundle approach that incorporates evidence-based best practices into everyday workflows to decrease HAIs. This process involved a multidisciplinary team where everyone was at the table to discuss how the bundle would be operationalized and how it would impact clinicians' daily workflows.

We rolled out the new care bundle approach in December. It's been very eye-opening to track and visually display our performance on daily improvement boards to see where we are having challenges. For instance, part of the care bundle involves giving patients with central lines a chlorhexidine gluconate bath. We got our first batch of data back and realized this action wasn't getting documented in the chart, which points to either a documentation problem or a process problem. We wouldn't have known about that care gap had we not tracked it.

Q: How did you educate front-line staff about the new care bundle approach and get them on board with the initiative?

AG: It's really about delivering the why. With our care bundles, we work with our education team, our nursing leaders and others to make sure we're getting the information out to the front-line staff. That education involves not only an understanding of how to do the standard work, but more importantly the why behind it. Involving front-line employees in the performance improvement work is how it really clicks for them. They can visually see where gaps are in the care and take more ownership of it. Understanding the why continually reinforces that. People are naturally competitive, especially in healthcare. They want to get to that zero HAIs mark, so engaging them in the process is almost the best education you can give them. 

Q: What emerging technology or capability shows the most promise to help reduce HAIs?

AG: To me, it's not about the technology, but about developing standard work. It's also partly a cultural thing, recognizing that when we do procedures on patients, there is always potential risk for harm. Using that as a frame of reference, I think we have to be very disciplined on how we use these devices. Does every patient require a central line or indwelling catheter? Or are we using these more as convenience tools when they are not always needed? It's about becoming much more disciplined in thought and developing standard work around that.

Q: How did your experience working for the U.S. Department of Homeland Security change your views on healthcare and public health?

AG: Working on health issues for Homeland Security was not completely different than the healthcare system work I do now. We thought about a lot of the same issues at Homeland Security, just on different levels. At DHS, some of the biggest things we worked on were infectious disease agents. When I first became CMO for DHS, it was in the middle of the H1N1 pandemic. All the government's plans focused on addressing Avian influenza H5N1 coming from the far East, and then H1N1 showed up in California and Texas before we even knew it. That just shows you how much planning under the wrong assumptions can lead you astray. 

One of the things we always stressed at DHS was that we never wanted to be in a defensive or reactive position. It's all about prevention. If you take that mindset out of the Homeland Security world and apply it to healthcare, it's the same thing. We want to prevent safety issues and infections from happening to our patients. 

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