Nosocomial infections: Aligning strategy and action from mission to outcomes

Outstanding health care institutions around the world lead, in effect, by setting an example and keeping hospital-acquired infections to a minimum. Behind the apparent simplicity of an indicator hides an enormous complexity. We believe that the difficulty in achieving seemingly simple benchmarks stems from the necessity to perform optimally at different levels of the organization consistently. This challenge can be summarized in a word: alignment. Institutional alignment starts with the mission and must be ubiquitous. Achieving the benchmark illustrates the elusive trait of institutional coherence. We will describe the dimensions and levels at our institution that influence our ability to strive for better indicators in the prevention of nosocomial infections, examine some of the difficulties and provide a few examples of success.