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INFECTION PREVENTION 1 5 8 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 4 Four key dynamics Sending e-mail to a large distribution list made sense from a purely practical standpoint. Ours is such a large facility, it was hard to track down everybody I needed to update every week about the status of our interventions. But the mass communication also put several other key dynamics in motion. Those were what ultimately made the differ- ence. • Peer pressure . The distribution list included the C-suite, and every e-mail that went out included not just the number of new cases per unit and a comparison of units, but also the findings of environmental cleaning, of environmental cultures, of hand hygiene, of hand cul- tures, of all the interventions we were trying to employ at the time. Everyone was under the microscope and nobody wanted to be seen as the worst. People were keenly aware that top management was being kept informed and that the executives understood that it was a problem that could be corrected with the right measures. All of that added up to a healthy dose of peer pressure. • Engagement. Before I started sending out the e-mails, there was a lot of discussion about the kinds of steps we needed to be taking. But people weren't fully engaged. For the inter- ventions we were trying to implement to be fully effective, people needed to be engaged enough to do them consistently, as opposed to discussing them a lot and actually doing them only periodically. • Accountability. By providing greater visibility, the e-mail made peo- ple and units more accountable. Until then, the problem could be seen as a facility-wide issue, and it was easier for individual units to escape scrutiny. But when we broke the information down into smaller seg- ments, individuals could be called upon to explain why the problem seemed especially acute in their areas. • Leadership. Units are sometimes driven enough to acknowledge OS_1406_part3_Layout 1 6/13/14 11:56 AM Page 158