Monday, May 6, 2019

Infection Prevention: Buy In Versus Responsibility

For some, this may be disagreeable.

I have been giving the concept of 'buy in' some thought lately. I came across this article on shared governance  and the roll of buy in in bringing about change.

Let's define buy in as engagement and ownership in a system, process or issue. This connotes an option to participate (or not) in a change process. 

Shared governance in theory promotes buy in as it allows healthcare workers greater autonomy over their practice. This is preferable to a top down approach.

However, buy in of infection prevention best practices (hand hygiene, safety checklists, surgical time outs, perioperative antibiotic use, chlorhexidine patient bathing of ICU patients etc) falls short of the ethical responsibility of primum non nocere. Our ethical duty to maximize risk reduction in healthcare is explored here

Buy in and shared governance allows for optionalism, lack of standardization, scant accountability and overall poor risk reduction. If everyone is in charge, no one is.

So beware, for matters of patient safety, where published, evidence based interventions exist, opting for a slow and cumbersome buy in process through shared governance leads to slow and variable change. Accountability and standardization are commonly lacking. 

Sadly, patients are harmed.