|
|
马上注册登录，享用更多感控资源，助你轻松入门。
您需要 登录 才可以下载或查看，没有账号？注册
|
×
院感人总是苦于院感防控措施落实不到位，每每此刻总是将抱怨洒向执行人员，包括护士、医生、医技人员，抱怨他们依从性不够，但却往往忽略了院感的实际情形，忽略了医务人员的实际情况，本文独辟蹊径，也算是给所有从事院感防控的人员提供了另外一套思路，希望有所启发。
Infection Control & Hospital Epidemiology (2018), 0, 1–2doi:10.1017/ice.2018.189
Letter to the Editor
Hospital epidemiologists and the art of salesmanship
医院流行病学家和推销艺术
Daniel J. Sexton MD, FIDSA, FSHEA
Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
To the Editor—A recent editorial in The Wall Street Journal by Stewart Easterby, a management consultant, entitled “Climate Activists Are Lousy Salesmen”1 led me to suspect that poor salesmanship is a common flaw among American hospital epidemiologists. Even successful hospital epidemiologists routinely encounter nurses, physicians, other healthcare workers and administrators who are dismissive of many evidence-based protocols for infection prevention. Could this failure to communicate be due in part to our lack of skills in salesmanship?
致编辑—“华尔街日报”最近由一位名为Stewart Easterby的管理顾问发表了一篇社论，题为“气候活动家是糟糕的推销员”，这也让我怀疑，糟糕的推销技巧是美国目前医院流行病学家的常见缺陷。即使是成功的医院流行病学家也经常遇到护士、医生、其他医护人员和管理员等对许多基于证据的感染预防方案不屑一顾。这种沟通失败的部分原因可能是我们缺乏推销技巧吗？
Stewart Easterby argues that politicians, scientists, and the media—collectively defined as “climate activists”—have failed to convince most Americans that the Earth is on a path to “catastrophe.”1 Repeated calls for radical remedies have fallen on tens of millions of deaf ears for multiple reasons. First, a proportion of prominent “climate crusaders” lack clarity and a human touch when advocating for radical economic and social changes. Use of vague words like “climate change” baffles the public. Only a few members of the public understand or can assess the scientific validity of climate research. And many studies and models cited by qualified experts as scientific proof of climate variations have not been explained in clear layman’s terms.
Stewart Easterby认为，政治家，科学家和媒体等“气候活动家” 未能说服大多数美国人认为地球正处于“灾难”的道路上。有多种原因导致对这些激进的补救措施反复得充耳不闻。 首先，一些着名的“气候十字军”在倡导激进的经济和社会变革时缺乏清晰度和人性化。使用像“气候变化”这样模糊的词语会让公众感到困惑。只有少数公众了解或可以评估气候研究的科学有效性。许多由专家引用的研究和模型作为气候变化的科学证据尚未用明确的常用术语来解释。
The public has grown weary of sensational news stories of climate studies that have subsequently been debunked or discredited .And millions of average citizens believe that they cannot change the climate even if they fully embrace complicated, expensive, and inconvenient remedies to problems that will persist well beyond their natural lives.
公众已经厌倦了气候研究的耸人听闻的新闻报道，这些报道随后被揭穿或声名狼藉。数百万普通公民认为，即使他们完全接受复杂、昂贵且不方便的补救措施，他们也无法超越自然生活来改变气候。
Finally, and most importantly, millions of Americans become resentful when climate crusaders proclaim that “climate deniers” are a major reason that many policies, laws, and treaties have failed to either be enacted or be effective.
最后，最重要的是，当气候十字军宣称“气候否定者”是许多政策、法律和条约未能制定或有效的主要罪魁时，数百万美国人变得怨恨。
This synopsis has similarities and parallels in our world of hospital epidemiology. Although time pressures, inadequate staff education, and inadequacies in human factors engineering commonly lead to noncompliance with infection prevention measures, most of us hospital epidemiologists have at some time blamed our colleagues for the sorry state of poor compliance with prevention measures such as hand hygiene, isolation protocols, sterile techniques, and surgical infection prevention protocols. Our colleagues know this and often resent it. Virtually all healthcare workers want to do the right thing, but often they are too busy, improperly educated, or rightfully annoyed with cumbersome processes such as using gowns for isolation that they believe add no value to the care they provide.
上述情况在我们的医院流行病学界中也有相似之处。虽然时间压力，员工教育不足以及人因工程设计不足通常导致不遵守感染预防措施，但我们大多数医院流行病学家在某些时候都会指责我们的同事，对他们在手卫生、隔离方案、无菌技术和手术感染预防方案等预防措施的不良遵守情况感到遗憾。我们的同事知道这一点，并经常表现出反感情绪。几乎所有的医护人员都希望做正确的事情，但往往他们太忙，接受了不正当教育，或者对繁琐的程序表示厌恶，例如使用隔离衣进行隔离，他们认为这对他们提供的护理服务没有任何价值。
Hospital epidemiologists have made clarion calls about their deep concerns regarding emerging antimicrobial resistance. However, our remedies too often strike clinicians as impractical, inconvenient, unproven, invalid, and/or futile.
医院流行病学家已就他们对新出现的抗菌药物耐药性的深切关注发出了号角。 然而，我们的补救措施常常使临床医生感到不切实际、不方便、未经证实，无效和/或徒劳无功。
Antimicrobial resistance has been evolving for over 75 years and, like climate “deniers,” clinicians and nurses, even those who realize and admit that “bad bugs” are a big problem, are “ . . .naturally disinclined to obsess daily about a phenomenon that started long before they were born and won’t reach fruition until long after they die.”1 As a result, large numbers of clinicians, while acknowledging the problem of antibiotic resistance, continue to overprescribe antibiotics in their daily practice.
抗生素耐药性已经持续了超过75年，并且，像气候“否认者”一样，临床医生和护士，甚至那些意识到并承认“超级细菌”是一个大问题的人，都是“。。 很自然地不愿意每天都想到这种现象，即早在它们出生之前就开始了，直到它们死后很久才会实现”。结果，大量的临床医生在承认抗生素耐药性的同时继续在他们的日常实践中过度使用抗生素。
Perhaps the disconnection between our concerns about patient safety, infection prevention protocols, and antimicrobial resistance and their half-hearted acceptance by many of our colleagues can be explained by our lack of expertise in salesmanship.
也许我们对患者安全、感染预防方案和抗菌素耐药性的担忧与我们许多同事的半心半意的接受之间的脱节，可以解释为我们缺乏推销技巧方面的专业知识。
How can we change the status quo? To begin, we should directly acknowledge that we are unable to definitively and temporally determine the cause or causes of transmission of numerous pathogens because of the complexity of modern healthcare, the enormous numbers of personal touch interactions between staff and patients and the movement of patients within the modern health system. Indeed, studies employing whole genomic sequencing methods have illustrated the complexity of unresolved questions about the transmission of Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and methicillin resistant Staphylococcus aureus.2–4 Our lack of evidence on these fundamental points results in widespread skepticism when we propose that implementing a “bundle” will reduce infections or that handwashing is a panacea for reducing infections in complex and highly contaminated environments full of sick patients receiving extraordinarily complex care.
我们怎样才能改变现状？ 首先，我们应该直接承认，由于现代卫生系统中医疗保健的复杂性，员工与患者之间的大量个人接触互动，以及患者内部的流动，我们无法明确地、并从时间上确定多种病原体病因或传播的原因。 事实上，采用全基因组测序方法的研究已经说明了关于艰难梭菌、耐碳青霉烯酶肠杆菌和耐甲氧西林金黄色葡萄球菌传播中未解决问题的复杂性。当我们对这些基本点缺乏证据时，当我们提议实施“集束化措施”将减少感染，或洗手是减少复杂和高度污染环境中发生感染的灵丹妙药时，如果对这些基本点缺乏证据，我们会普遍持怀疑态度。
As Easterby suggests in the editorial cited above, we may attract more supporters and believers if we create a clear, consistent call to action using convincing spokespersons with local and/or national credibility. Overtly strident or overconfident hospital epidemiologists who advocate unproven protocols or policies are unlikely to stimulate cooperation from healthcare workers. Although simple measures and multipart bundles often improve outcomes, such bundles will not solve many refractory and vexing problems related to preventing transmission of healthcare pathogens nor will they work in all healthcare settings or systems.
正如Easterby在上面引用的社论中所提示的那样，如果我们通过雇用当地和/或国家的令人信服的发言人来制定明确、一致的行动呼吁，我们可能会吸引更多的支持者和信徒。那些过于强烈或过于自信的医院流行病学家，提倡未经证实的协议或政策时不太可能促使医护人员的合作。尽管简单的措施和集束化措施通常可以改善效果，但是这些集束化措施不能解决与预防医疗保健病原体传播相关的许多棘手的问题，也不会在所有医疗环境或系统中都起作用。
We need to better “label” our programs, policies, and protocols. These labels and our terminology should be credible, accurate, consistent, logical, and understandable. For example, slogans such as “getting to zero” are not plausible, and our colleagues know this. On the other hand, honest and humble messages that emphasize that individuals and institutions should persistently and incrementally strive to do the best they can do to reduce HAIs and improve patient safety are more likely to achieve acceptance by staff who have varying roles and priorities and numerous other job-related concerns.
我们需要更好地“标记”我们的程序、策略和协议。这些标签和我们的术语应该可信、准确、一致，合乎逻辑且易于理解。例如，诸如“getting to zero”之类的口号并不合理，我们的同事也知道这一点。另一方面，强调个人和机构应该坚持不懈地逐步努力减少HAI和提高患者安全的诚实和谦逊的信息更有可能获得具有不同角色和优先级，及其他有与工作有关诉求的工作人员的认可。
We also need to recognize that our efforts to reduce antimicrobial resistance should be tempered with the reality that many of its causes are not amenable to direct intervention by individual doctors, healthcare systems, or government agencies. Burdening clinicians with this responsibility or blaming them when resistance gets worse makes our job harder when were commend partially effective but still useful changes in policies, protocols, and care practices. Instead, we may have more credibility and impact by focusing on explaining and attempting to address basic principles, the relationships between colonization and subsequent infection, the role of local antibiotic pressure and local emergence of resistance, and the adverse risks of devices.
我们还需要认识到，我们减少抗菌素耐药性的努力应该适应这样的现实，即许多引起抗菌素耐药的原因不是个别医生、医疗系统或政府机构可以直接干预的。当在遵循政策、协议和护理实践中表现出部分有效但仍然有用的变化时，担负重任的临床医生或在耐药情况更加严重时归咎于他们，会使我们的工作更加困难。相反，我们可以通过专注于解释和强调基本原则、定植和随后的感染之间的关系、当地抗生素压力的作用和当地抗药性的出现，以及设备的不利风险来提高可信度和影响力。
We should endorse Easterby’s recommendation that activists need to listen to their doubters and resist, as best they can, temptations to lambaste them when their opinions clash with ours. Hospital epidemiologists who occasionally disparage colleagues who doubt, ignore, or are indifferent to our efforts are more likely to be frustrated than successful.
我们应该支持Easterby的建议，即活动家需要倾听他们的怀疑者，并且，当他们的意见与我们的观点发生冲突时，尽可能地不要去贬低他们。偶尔贬低那些对我们的努力表示怀疑、忽视或漠不关心的同事的医院流行病学家比成功更让人感到沮丧。
Also, we need to fix “computer models” overly reliant on flawed surveillance definitions. It is often counterproductive to rely on metrics and outcomes such as C. difficile “lab ID events” that currently cannot reliably distinguish between true infection and colonization or endorsing and using flawed definitions of a catheter-associated bloodstream or urinary tract infection. Many of our colleagues are skeptical because they correctly realize that use of these metrics to assess and monitor the impact and efficacy of specific prevention protocols and policies is often misleading. We need to develop surveillance definitions that are clinically accurate; comprehensible to clinicians; and have clear impact on clinical practice, quality, and safety. Otherwise, we will continue to experience the same skepticism and indifference that climate activists encounter when then rely on unintelligible and sometimes inaccurate National Oceanic and Atmospheric Administration climate data.
此外，我们需要修复“计算机模型”过分依赖有缺陷的监视定义。依赖艰难梭菌“实验室ID事件”等指标和结果往往会适得其反，这些事件目前无法可靠地区分真正的感染和定植，或支持和使用导管相关血流或尿路感染的有缺陷的定义。我们的许多同事都持怀疑态度，这是由于他们正确地意识到使用这些指标来评估和监控特定预防方案和政策的影响和效果往往会产生误导。我们需要制定符合临床的准确的监测定义；临床医生易于理解；对临床实践、质量和安全性产生明显影响。否则，我们将继续遇到气候活动家在依赖难以理解且有时不准确的国家海洋和大气管理局气候数据时遇到的同样情形，即怀疑和漠不关心。
Finally and most importantly: how can hospitals epidemiologists become better salesmen? For starters, we can collectively and individually alter prior behaviors and approaches that have led to failure. We should stop assuming that apathy or ignorance of our physician and nursing colleagues are behind the frequent failure of our protocols, policies, and recommendations. All of us need to become better versed and trained in the arts of salesmanship, negotiations, active listening, communication and even marketing. Multiple on-line and on-site training programs are available for developing these and standard business and sales skills. Some of us could benefit from hiring a personal coach to provide individual help and feedback. We can also learn by observing and mimicking effective people who understand and are skilled in sales and marketing. Our society should be urged to collectively and publicly petition The Centers for Disease Control to revamp or even abandon flawed surveillance definitions. Our society should stop overt or tacit support of the use of inaccurate and flawed metrics to punish hospitals. We need to realize that many of our prior efforts have failed because we, too, lack “clarity, credibility, and empathy” in dealing with our fellow healthcare brethren.
最后也是最重要的一点：医院流行病学家如何成为更好的销售人员？对于初学者，我们可以集体和单独地改变之前导致失败的行为和方法。我们应该停止想当然的认为我们的医生和护理同事的冷漠或无知是导致我们的方案、政策和建议经常失败的原因。我们所有人都需要精通和熟练销售、谈判、积极倾听、沟通甚至营销方面的技巧。目前已有数个在线和现场培训项目可用于发展这些业务和销售技能。一些人可以通过雇用私人教练来提供个人帮助。我们还可以通过观察和模仿那些擅长销售和营销人员来不断学习。应敦促我们的社会公开地请求疾病控制中心改变甚至放弃有缺陷的监测定义。我们的社会应该停止公开或默许支持使用不准确和有缺陷的指标来对医院进行惩罚。我们要认识到，我们之前的许多努力之所以都以失败告终，是因为我们在与医疗保健者打交道时缺乏“清晰度、可信度和同理心”。
Although effective hospital epidemiologists utilize numerous other “tools and assets,” such as negotiation and complex strategies requiring flexibility, compromises, relationship building, and priority setting, salesmanship is too often underutilized. But salesmanship alone will never be a panacea. Even if we achieve reasonable competency in the preceding skills and techniques, we will still periodically encounter failure, frustration and disappointment. And when these failures and frustrations occur, I advise making our best effort to sustain our focus and retain our optimism and goals while pondering Shakespeare’s famous line: “The fault, dear Brutus, is not in our stars but in ourselves, that we are underlings.”
尽管医院流行病学家可利用许多其他“工具和资产”，例如谈判，以及需要集灵活性、妥协性、关系确立和优先级设置等于一体的复杂策略，但销售技巧却往往未得到充分利用。但仅仅依靠推销技巧永远不会成为灵丹妙药。即使我们上述的技能和技巧上达到一定的能力，我们仍然会经常遇到失败、沮丧和失望。当这些失败和挫折发生时，我建议尽最大努力保持我们的关注度，并保持乐观和目标不变，同时思考莎士比亚的着名路线：“亲爱的布鲁图斯，人们可支配自己的命运，若我们受制於人，那错不在命运，而在我们自己”。
Acknowledgments.Financial support. No financial support was provided relevant to this article.
Conflicts of interest. The authors reports no conflicts of interest relevant tothis article.
References
1. Easterby S. Climate activists are lousy salesman. The Wall Street Journal,April 25, 2016.
2. Price JR, Golubchik T, Coke K, et al. Whole genomic sequencing showsthat patient-to-patient transmission rarely accounts for acquisition ofStaphylococcus aureus in an intensive care unit. Clin Infect Dis2014;58:609–618.
3. Eyre DW, Cule M, Wilson DJ, et al. Diverse sources of C. difficile infectionon whole-genomic sequencing. N Engl J Med 2013;369:1195–1205.
4. Palmore TN, Henderson DK. Managing transmission of carbapenemresistantEnterobacteriaceae in healthcare settings: a view from thetrenches. Clin Infect Dis 2013;57:1593–1599.2 Daniel J. Sexton
D.B.L.
2018.9.5
|
|
发表于 2018-9-5 18:40
