Editor's blog 23rd December 2008: Branson in a pickle on MRSA

The political syllogism was brilliantly defined by the classic BBC TV series Yes, Minister, and it reads as follows:

Something must be done.

This is something.

Therefore this must be done.

Reading Richard Branson's PR team's latest placing of a story on the front page of BBC News Online, the syllogism of his argument was startling.

Here we go again. While it is clearly not an ideal option, NHS staff who are colonised with MRSA can still have patient contact provided they follow proper infection control procedures at every patient contact - handwashing; care and time changing dressings; care and time cleaning or changing catheters - you know, the boring stuff.

As well as the significant cost of Branson's suggestion of taking those staff off the wards for two weeks (which the article does acknowlegde),  there are not the a regiment of alternative staff available.

It also ignores the fact that patients themselves may be colonised with MRSA. Certain trusts, including UCLH, are already taking action to address this problam fast, and some very proactive PCTs have even got this going on in the community.

Branson's point about sacking managers who don't make changes ("if managers of hospitals are not obeying the rules that have been set by the NHS, those managers should be replaced") makes interesting assumptions about the possibility of changing culture in problem institutions. On the grounds of 'senior responsible officer' status, it is legally and procedurally right.

What works in infection control
Ginny Edwards Head of Targeted Support for the MRSA / cleaner hospitals team, Department of Health, has emphasised that key aspects to success have been ongoing measurement and monitoring; leadership at trust level and attitudinal change around patient safety, making it “everyone’s issue”.

Edwards explains that beating healthcare-associated infections (HAIs) isn’t easy, "but it isn’t rocket science. Diligence matters – it’s about doing things 100% right 100% of the time". Locally, she adds, the key is leadership. "Trusts who succeed found that they had to make HAIs a chief executive, management and leadership issue. And there are leaders at every level, on every ward and in every cleaning team.”

"And keeping on doing it systematically, week-in and week-out, and not slacking off effort after you see a drop – which often happens. We call the product ‘tough love’! And it works.”

Effective performance management involves feedback, Edwards stresses: “not just telling people what to do. Firstly, it’s giving them opportunities to improve, but making clear that if they don’t manage that, then it will become about performance management”.

Trusts had to put in balanced scorecards for boards and key performance indicators at ward levels, which were repeated frequently. Edwards notes that data time-lag cannot be countenanced: “you can’t do an audit that you have to send to the clinical effectiveness unit who you don’t heard back from for six months.

Renewing the connection between the board-level management and the front-line care deliverers of organisations was also crucial, she adds. “The story of the successful reduction in HAIs is the story of building effective and regular assurance links from ward to board.”