PICNet co-chairs, Dr. Judy Isaac-Renton and Dr. Elizabeth Bryce welcomed everyone to the Second Stakeholder Summit, noting that 90 stakeholders were registered to attend (Introductory Presentation). Dr. Bryce emphasized that a lot has been accomplished in a short period of time and noted that British Columbia is considered a leader this area. The rest of the country is interested in what PICNet is doing and hopes to learn from our experience.

A special visitor at the Summit is Genevieve Thompson, from Manitoba Health. Genevieve is here to learn from PICNet and share today’s findings with her colleagues in Manitoba. Other special guests include representatives from the Auditor General’s Office, Safer HealthCare Now! and the Public Health Agency of Canada.

Dr. Bryce reviewed the PICNet Steering Committee Representation and emphasized that this is a voluntary process. She noted that the tremendous progress that has been made by these volunteers indicates the strong commitment to infection control in British Columbia.

Dr. Judy Isaac-Renton reviewed the meeting goals and objectives:

Goal:To enable a broad representation of the stakeholder community to enhance their understanding of the Provincial Infection Control Network (PICNet).

Objectives:

• To provide highlights on PICNet’s progress to-date
• To articulate PICNet’s mandate and direction
• To review the structure required to support PICNet’s mandate and direction
• To review priorities for PICNet in the year ahead

Judy noted that it has been almost one full year since PICNet was established by the Ministry of Health. She emphasized that, in addition to celebrating achievements to-date, the Network is poised to move forward and build on the tremendous work that has already been done.

Barri Harris was introduced as the facilitator for the day.

Barri emphasized that there is a lot of information to share and working groups should be applauded for the tremendous work that has been accomplished during a time when things were evolving and structures were being established. She noted that the potential for PICNet is tremendous, and as a collaborative, the best way to achieve that potential is to get involved.

Barri reviewed the Agenda (Review of Agenda)

Margaret provided on overview on PICNet and how it has, and continues to evolve. She emphasized that every day new members are joining this collaborative process. She also noted that, while PICNet was formally established in January 2005, the first meetings didn’t take place until May 2005. That means the achievements that will be reported by each of the Working Groups have been accomplished within less than six months.

As mentioned, the first PICNet Stakeholder Summit took place in May and resulted in a number of recommendations that have since been addressed by the four Working Groups, including developing a(n):

• Infrastructure Working Group
• Communications Working Group
• Needs Assessment Working Group
• Urgent/Emergent Working Group

There were several other initiatives undertaken outside of these working groups, as priorities were identified and addressed. This included the plan to have an Ad Hoc committee look at PICNet’s roles and responsibilities related to the development, issuing and maintenance of guidelines for health care associated infections. Margaret noted that if guidelines exist and are acceptable to PICNet stakeholders, PICNet could endorse them. If they need work, PICNet could adapt them. If there are no guidelines, PICNet could develop some. The Ad Hoc committee would look at all the issues and put forward recommendations outlining PICNet’s roles and responsibilities in this area. (Highlight of PICNet Activities).

Kyle from Safer Healthcare Now! noted that, as important as it is, Safer Healthcare Now! is time limited. This program will need to link to Provincial bodies, such as PICNet for sustainability. He noted that they want to build the infrastructure to support quality improvement initiatives going forward. Partnerships are key to this.

Dr. Cutt’s presentation reviewed options for governance models and concluded that a Network model best meets the needs of PICNet. (Presentation on Governance) He noted that PICNet is a voluntary collaborative providing a “knowledge buffet” from which each participant can make choices. He emphasized that these choices offer variety but also ensure influence, leadership and advocacy.

• Establish a network model of governance for PICNet

Discussion:
When asked if he could give an example of a successful network governance model, Jim referred to the Canadian Institute of Chartered Accountants. He was involved with this organization for a number of years and felt the network model encouraged and supported effective collaboration within this group.He noted that one of the challenges facing PICNet is that there is more than one discipline within the network, although he doesn’t feel this presents a barrier to success.

The question of accountability was raised and Jim explained that this would be addressed within a strategic framework. He noted that there will always be a temptation to resort to hierarchy and emphasized that the best balancing factor of the model is the ongoing reassurance to participants that their trust will be honored. Information they share will not be used against them. The reinforcement of trust and the demonstration of progress/success will reinforce this. Participants will see the benefits of this model.

Concerns were raised regarding resources, and while you might build trust, you can’t maintain it without adequate resources to do what needs to be done. Jim acknowledged that this was a dilemma as resources are key. He noted that the PICNet budget is extremely limited, but felt this was appropriate as a standards process should be lean. PICNet generates guidelines; it is not involved in the operational implementation of those guidelines. That being said, financial feasibility should be factored into all PICNet’s recommendations – is it feasible? is it sustainable?. There is no point in recommending something if the stakeholders don’t have the resources to follow through. As well, if PICNet recommendations are not feasible for Health Authorities to implement within their existing resources, PICNet should be prepared to support them by advocating for additional resources on their behalf.

Nicki noted that the Infrastructure Working Group had to be very flexible in developing their plans/recommendations as they were working ahead of the governance model presented by Dr. Jim Cutt. This resulted in many changes in their approach and recommendations. She thanked members of her working group for their support and perseverance. (Infrastructure Working Group Presentation)

The Infrastructure Working Group Presentation reviewed the goals, planning process and recommendations for PICNet. Emphasis was placed on how PICNet seeks to influence decision makers and consult with partners. Diagrams highlighting this process were included.

The goals and objectives of the Infrastructure Working Group were:

• Advance the development of PICNet by creating a representative, responsive and transparent organizational structure.
• Design a structure for PICNet that enables it to be the thread that ties infection control practice together in British Columbia.

• Endorse a Knowledge Network Model for PICNet
• Endorse proposed Network Structure
• Endorse Network Management role to support PICNet operations
• Endorse the Network Principles to evaluate PICNet’s effectiveness.

Discussion:
The question was raised whether prevention and control should be separated into two separate standing committees as their activities were closely linked. The response was that it was felt that there is enough work to be done in each of these areas to justify having separate standing committees; however, it was acknowledged that the expectation was that these standing committees would often collaborate and form Ad Hoc groups that addressed items of concern to both.

The Infrastructure Working Group (IWG) Leads noted that the Governance Document provided the necessary framework to move forward with the infrastructure planning process. It was very difficult in the beginning, without this foundation. It was also noted that the Steering Committee process evolved over time, which added more complexity to the planning process. Sheila emphasized that this is a great example of a best practice process:

• IWG started, based on our experiences and knowledge
• then IWG looked at best practice research
• IWG identified a benchmark/standard to work toward (this is what PICNet is supposed to be doing as a network)
• IWG made recommendations

A concern was raised over the lack of formal representation/acknowledgement of the many professional bodies/organizations that should be considered partners in this process. The Working Group emphasized that this continues to be a work in progress and there are many more stakeholders/partners to be identified and incorporated into the plan. It was also noted that many members of the Steering Committee were selected because they wear several “hats” – representing disciplines, geographic areas and professional affiliations.

It was also noted that PICNet should not be reinventing the wheel – there are many foundations and structures out there that are doing good work. PICNet doesn’t need to duplicate this. The Working Group recognized that the role of PICNet is to develop new knowledge and put it out there. If there is work out there that PICNet can adopt and share, PICNet will do that. If there is work that needs to be adapted slightly and shared, PICNet will do that too. PICNet provides a vehicle for pulling knowledge and expertise/people/organizations together.

When referring to the diagrams presented, it was emphasized that the flow of information must go both ways – from PICNet to partners/stakeholders and back. The Working Group agreed.

Decision-Making
Dr. Jim Cutt

Jim’s presentation on Decision-Making (Presentation on Decision-Making) provided an overview of how PICNet should structure itself and the role of the Steering Committee. He advised that the Steering Committee would define a prioritized program of work for PICNet and then:

• facilitate,
• coordinate and
• integrate the work of stakeholders across the province.

This will ensure information is shared and will also facilitate agreement with regards to Best Practices. It was emphasized that the Steering Committee would not be involved in detailed implementation, but should ensure that any recommendations were technically and financially feasible

This means optimizing efficacy within constraints or recognizing that additional resources are required and advocating for them. Jim noted that the biggest accountability is among peers and that compliance with PICNet recommendations is voluntary.

• Recommend a process for Steering Committee membership renewal on a regular, continuing basis (e.g. every 2 years) and obtain membership agreement for that process.
• Recommend a management infrastructure needed to achieve PICNet vision (e.g. membership voting and consensus, Steering Committee endorses, not approves).
• Recommend a process for generating Best Practice guidelines (e.g. invite broad feedback, use iterative review process, final documents are endorsed and published by PICNet).
• Complete work required for thorough testing of the knowledge management system

It was again emphasized that relationships with other organizations/bodies need to be formalized.
Microbiology labs were cited as an example. The BC Association of Microbiologists (BCCAMM) has a role in developing lab guidelines and works collaboratively province-wide.

Clay thanked the members of the Working Group. He noted that most of the WG members are infection control specialists, not communications professionals. He also thanked Margaret for her tremendous support and guidance throughout the process.

The Communications Working Group report (Communications Working Group Presentation) provided an overview of the process followed, a summary of the SWOT analysis (strengths, weaknesses, opportunities, threats) that was conducted, the tools that have already been developed and the recommendations for the future. It was noted that information/feedback received via the communications planning process was shared with the Steering Committee and resulted in the Governance/Decision Making planning process and recommendations. This is one of many positive changes/accomplishments taking place while the formal PICNet structure and processes were being established. Progress is being made!

• Confirmed name “PICNet”
• Completed a SWOT analysis
• Identified/resolved confusion regarding governance role
• Developed communications plan
• Developed Glossary of Terms
• Developed FAQs

• More actively promote PICNet within the infection control community.
• Ensure equal voices/representation
• Strengthen and promote website
• Implement the communication plan and provide focused communications resources

Margaret explained the glossary is a living document and is constantly evolving as members provide feedback. Bruce Gamage has been leading this role for PICNet. It is on the website; if you come up with a term or identify a term that you feel is missing let us know. The same goes for the FAQ (frequently asked questions). What questions are you being asked, or do you think are being asked?

It was emphasized that the role of communications is integral to the work of PICNet. While not seen as a separate partner, communications expertise and strategies must be incorporated into everything PICNet does.

Colleen presented with Chris Corbett, a consultant assisting with the needs assessment. Colleen emphasized that this is a work in progress and there is still lots to do. Working Group members are urged to stay with the process until it is done. The Needs Assessment Working Group Presentation (Needs Assessment Working Group Presentation) reviewed the mandate and process followed by the group. It was emphasized that only an estimated 10% of medical practices are evidence based. Most current practice is based on experience of the practitioners. There is a movement towards evidence-based practice, but it will take time.

The resources available on the PICNet website were highlighted. The Needs Assessment Working Group has identified and posted a broad range of documents and literature on the site.

• Extend deadline for data collection until the end of January.
• Extend final draft report to Feb/March 2006

A brief presentation was provided on the P2P information management system by Chris Corbett. P2P is a web-served application that creates a confidential knowledge management work space for health professionals. It is where the information collected via the Needs Assessment is being housed. P2P can also been used by working groups to have access to knowledge tools and specific information in a secure manner.

Concerns were raised regarding the online questionnaire. It was felt that it was too broad and that it will be very difficult to pull out relevant information in useful way. For example, the need to collect sufficient “denominator” information in Public Health was debated.

The goal of the Urgent/Emergent Working Group was to develop and test the processes for PICNet to be involved in managing healthcare associated infection prevention, surveillance and control issues in BC (Urgent/ Emergent Working Group Presentation). The Urgent/Emergent WG Report provided an overview of the process, highlighted their accomplishments and explained the roles and results the CDAD Ad Hoc Working Group. The group emphasized that they wanted to keep things moving, so that while PICNet is developing it is also delivering.

• Developed tool for objectively prioritizing projects/issues
• Used the tool to prioritize 8 issues that were referred
• Established an Ad Hoc Working Group to address to[ priority issue (CDAD)
• Working on 2^nd ad hoc group
• Developed process for initiatives to be developed/approved by PICNet
• Developed position paper on PICNet roles in an emergency

• Confirm/finalize CDAD process as a good test of system
• Evolve CDAD Ad Hoc WG into a PICNet Standing Committee
• Consider/endorse discussion paper on PICNet roles in an Emergency
• Consider/prioritize list of Potential Issues for PICNet to address

A comment was made that it may not be realistic to think that CDAD surveillance will be implemented universally in the New Year. Margaret responded that this is exactly why we want to move ahead with the CDAD project…to learn about what the issues are re: implementation. PICNet members know that they need to ensure that what PICNet put forward is feasible and practical. The PICNet community of practice must also advocate for resources. However, one must keep in mind that these recommendations are voluntary. Some organizations are happy to adopt these tomorrow; others don’t see the need right now. Bottom line, if PICNet can prove the benefits, through evidence and recommendation of best practice guidelines, it will be difficult for the health authorities to ignore these practices in the long run.

Margaret reviewed the day and summarized next steps for PICNet. First and foremost, she celebrated the accomplishments of the Working Groups and thanked everyone for their efforts and expertise. She noted that all recommendations will be reviewed by the Steering Committee on Monday, December 19^th, 2005. The expectation is that by the end of the Steering Committee meeting PICNet will have a plan for moving forward in the year 2006.

The following are the priorities being taken forward to the Steering Committee for consideration on December 19^th, 2005:

Discussion:
Ensuring PICNet’s community of practice included groups like the BC Medical Association and the primary care community was recommended. Margaret suggested that this could be addressed through implementing the communication strategy as PICNet works to identify, engage and share information with all stakeholders.

Another suggestion was to get health authorities to sign off on PICNet. However, it was noted that the role of PICNet is mandated by the Ministry of Health and formal approval from the health authorities is not required.

Concerns were expressed regarding the lack of attention to recruitment and retention priorities for infection control practitioners. How will PICNet address these issues? Margaret explained that this is incorporated into the Needs Assessment – the group couldn’t speak to resource issues today because they haven’t received all the info from the health authorities and PICNet always wants to produce evidence to support its recommendations. This information will be tabled at the next Stakeholder meeting in June 2006.

There was a discussion relating to PICNet’s role in research. Some feel the main purpose of PICNet should be to share best practices (and communicate). Others suggested that PICNet doesn’t necessarily have to take a lead in research, but it may be involved in a coordinating manner. Margaret explained that PICNet’s role related to research has yet to be defined and will be put down as a “to do” for PICNet.

Margaret thanked everyone for their participation and attendance at the 2nd PICNet Stakeholder Summit. It is very exciting to see the progress that has been made in the past six months. She presented certificates of appreciation for the work of the Working Group Leads in moving forward the work of PICNet.

She noted that many attendees have only recently learned of PICNet and encouraged everyone to spread the word when returning to your organizations and suggest to your colleagues that they visit the website. The lanyards given out have the PICNet website address on them.

Judy Isaac Renton also thanked the group leaders and all participants. She also recognized Margaret and her team for their tremendous efforts and support. She looks forward to seeing everyone again in June 2006 at the Third Stakeholder Summit.

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