Superbug clean up

Since 2004, healthcare associated infections (HCAI's) and the fight to provide cleaner hospitals has become one of the 'hottest' healthcare topics and a very high priority at the Department of Health (DH).

MRSA and C Difficile are the main infections the DH are seeking to control and in November 2004 it announced new infection reduction targets. Education of healthcare professionals became a key part of this strategy and an online learning programme was launched for all clinical staff in the NHS.

This achieved some success with nursing staff, but proved less effective with doctors, who viewed the content as less relevant to their profession and not convenient to their schedules. A new approach was needed if the DH was to reach its objectives.

Doctors.net.uk (DNUK) was quickly recognised as a unique channel capable of providing an education solution for the HCAI team to reach doctors using a trusted medium.

Objectives
• To develop online educational models to meet the objectives of reducing infections by 50 per cent
• To reach and engage doctors working in hospitals in England with the training and achieve completion of 1,500 modules (pilot scheme) and 6,000 for the full roll out
• To evaluate the user experience and educational outcomes of the material
• To track all participation and provide reporting to each Strategic Health Authority (SHA).

Online interactive modules addressed by the HCAI objectives to reduce infections by 50 per cent

Tactics
DNUK developed an integrated communications approach to ensure awareness, effectiveness, reach and to maximise behavioural change.

The training content was authored by a team of medical writers and clinicians according to the educational objectives specified by the chief microbiologist for England – Professor Brian Duerden. The programme was then promoted to secondary care members of DNUK through the unique engagement channel.

An initial pilot programme proved to be highly successful and following this phase, the DH recommended the DNUK education modules to each SHA lead. A full roll out of the programme was then commissioned.

The expert medical education team at DNUK developed two modules on infection control. These were online interactive learning modules that could be started, paused and completed at any time from within the workplace and at home. There was also a range of resources available to provide additional information and assist doctors with preparation in teaching colleagues. A microsite was built to support the materials, raise the profile of the modules and provide even easier access for users.

DNUK also developed a full digital communications plan to reach the target audience: doctors working within the NHS, from its membership base of more than 163,000 doctors, segmented according to speciality and seniority. 

This plan included the creation and set-up of targeted activity, newsfeeds, forums, podcasts, a targeted email contact strategy, polls and intelligent cross-marketing activity.

Results 
• Pilot – target of 1,500 modules completed and exceeded in just 22 days
• Full roll out – target 6,000 modules completed by July 2008
• In the first three months, 20,945 doctors interacted with the disease area of the site 40,221 times
• Pass rates for both module = 99 per cent
• Widespread adoption with little resistance
• 97 per cent of doctors said they would modify their clinical practice after completing the modules
• Creation of a proven and scalable model

The wider impact:
• The potential cost of delivering this training to doctors through face-to-face classroom methods can be conservatively estimated at £100 per doctor
• The cost of one-to-one engagement with this programme was a fraction of this
• Environmental benefits of removing 7,500 doctors from the road
• Impact on patient care – keeping doctors on the wards
• Reductions in deaths and morbidity
• Reduction in prolonged stays in hospitals
• Newspaper headlines – 'NHS Superbug infections down by a third in a year'
(The Times,  September 19, 2008). 'NHS hits target of halving superbug rates in hospitals' (Evening Standard, September 18, 2008).

Evaluation
The application of the HCAI modules has been hailed as a great success for all key stakeholder groups.

"DNUK is the easiest and most efficient way of reaching doctors en masse. We have found eCME to be the most effective way to reach and train the optimum number of doctors required to meet our targets. The fact that the modules are accredited, convenient and simple to use made it first choice for SHAs," said Daniel Crosariol, communications manager, Healthcare Associated Infection and Cleanliness Division, Department of Health.

Dr Tim Ringrose, medical director at Doctors.net.uk, commented "This is a great example of how online can successfully deliver vital learning to a scattered group of busy professionals in record time. What helped this programme to deliver where others sometimes fail, was careful authoring to match the needs of intended audience, high profile promotion to outline the benefits of the module and use of a trusted channel to host the content."

The programme went on to win the E-Learning Age Gold Award for Best E-Learning Project Securing Widespread Adoption in November 2008.

Case study details

Client: Department of Health
Agency: Doctors.net.uk
Campaign: Education in Healthcare – associated infection
Timescale: Throughout 2008