Next Steps

 1.     Continuation and further creative development of the activities of Phase I (Motivation & Creating Health Awareness) and Phase II (Data collection & surveys) to allow the support of the next phases.

2.     Regarding Phase III (Supply Availability):

a.     Continuation and using our experience to further develop the processes of deficit definition, supply purchasingb.    Maintaining the established system of supply delivery to the hospital and subsequent follow up process of the use of these supplies. Preparations for the delivery of a new set of supplies will be done in May 2008.c.     We are yet to start an improvement project for the supply management system. This involves ensuring the presence of the right supply item to the right person at the right time. We are now ready for this step since we have performed a descriptive analysis of the current system.

3.     Regarding Phase IV, Our Infection Control Supervision strategy at the time being depends on continuous presence of volunteers during the period described above. At the time being, the volunteers making friends with the nurses and only giving advice. Later in May 2008, creative competition & rewarding systems are to be implemented and later punishment systems in co-ordination with the hospital management.

In terms of the current guidelines (injection anti-infection) and geographical areas that are supervised by the team:

a.     The team plans to maintain such an intensive presence of supervising volunteers for at least 6-12 months. Our volunteers and our recruitment system have the potential to maintain this presence for years and possibly as continuous "permanent" members of the hospital system. The team plans to withdraw volunteers when the material evidence is in place that the knowledge and behavior of nurses have really changed and that they will spontaneously perform the correct actions. Withdrawal in this case will be gradual and not absolute. The team also plans to always maintain the supply of at least the minimum number of supervisors that can maintain the derived achievements.

b.     Measurement of short-term achievements - end of June 2008 and onwards, is to maximize the compliance of the medical team in the presence of the intensive supervision system described. The teams plans to reach the  SMART Goal [1] by the end of June 2008: 80% compliance with the injection anti-infection standard guidelines in the period from 8:30 to 10:00 am, the maximum risk period, all over Internal Medicine Hospital (Basic goal) or at least in the 4^th floor (Minimum goal). This shall be measured by a survey using the same checklist as the one used in the baseline assessment.

c.     Measurement of long-term achievements - end of September 2009, will be to maintain the same compliance by deep changes in the attitude and behavior of the medical team with minimal presence of supervisors and possibly even in the absence of any supervision.