I am going to limit this commentary exclusively to hospital infection prevention. We are searching for high reliability in infection prevention, this means that evidence based risk reduction practices are implemented in a systematic and consistent way. To succeed, we need to standardize, educate, implement (this includes providing the materials and infrastructure to support the intended behavior) assess performance and provide non-punitive feedback (particularly when errors occur).
These efforts, without a doubt, improve practice and minimize system failure, but they only go so far. The last critical step is accountability. Poor performers and recalcitrant outliers must be held accountable by institutional leadership for non-adherence to evidence based, reasonable infection prevention expectations.
Low reliability infection prevention cannot habitually default to the 'system failure' excuse.
To borrow a quote: The culture of any organization is shaped by the worst behavior that a leader is willing to tolerate.
