HIV: Patient Safety and Infection Prevention in India

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Guest blog by Vijay Yeldandi 

Why IPP? Honestly because I needed a navigator! After 25 years of doing public health work in India focusing on HIV Infection Prevention, I realized that not everything I did was a resounding success. While some projects were gratifying, in retrospect there were many hard lessons to learn and much heartburn to endure. Many of my friends and colleagues would remark “Oh there goes Vijay again….. where angels fear to tread…. Yes, it is true I have always been an unapologetically optimistic (hopelessly romantic) Gandhian revolutionary going about trying to make the whole world a better place. My anthem is John Lennon’s IMAGINE https://youtu.be/SfGuTigICo8

Although some of my work in India is funded by the United States Centers for Disease Control & Prevention, my greatest obsession “Patient Safety and Infection Prevention” focusing on public health institutions in India is not. Giving up on what I believe in passionately has never been an option in my entire life. When I first started, it was daunting to even comprehend the incredible complexity and difficulty of what I had set out to do. Fundamentally transform the entire state of Telangana’s government owned health facilities approach to “Patient safety and Infection Prevention”. As a private individual with neither money, power nor influence! it is as Quixotic as it gets. My experience told me I had to have a coherent strategy and avoid making mistake. I had been reading the works of Albert Hirschman, Michael Woolcock, Matt Andrews. I sorely needed to have a better understanding of how to address “Health” as a complex adaptive system.

And then the COVID pandemic hit! I despaired of ever getting my project off the ground. I had been diligently working with several of my colleagues alerting them to best practices to reduce the spread of COVID infections and the Superintendent (Dr. Ramkishan Dharmakari) of the Government Hospital in Mahaboobnagar in Telangana State. We constantly discussed how we could work to create a “Patient Safety and Infection Prevention” program for his hospital that could be a model to be emulated by other Government Health Care facilities throughout the state.

When I applied to be enrolled in the IPP course I had low expectations that I would be accepted in such an elite program at one of the world’s greatest universities. At every step of the course, I felt like finally the cobwebs in my thinking were being systematically eliminated, it was absolutely exhilarating to have somebody holding my hand encouraging the audacity of my purpose and project. In the early part of my project, I seemed to be getting nowhere because for a project of this kind we needed the blessings of the political elite and key administrative officers responsible for approving funding of the hospital. The course helped me think through and work at getting the authority from the political elite by a combination of perseverance and networking with influencers of the political elite. When finally, the State Ministers blessed the project they took it upon themselves to come to the hospital and inspire the entire establishment to put their heart and soul into the project. I was simply blown away. The key things I took away from taking the course whilst I implemented the concepts in my project in parallel were:

  1. Clarity in defining the problem not only for myself but for all the important stakeholders particularly people whose blessing I would need to have the authority to proceed. The fishbone is a wonderful way of organizing the process.

When I started working with the hospital Infection Prevention team, we all realized it is best to start with a narrower focus, here again the key is problem driven iterative adaptation, so I revised the fishbone.

The team loved the fishbone concept and they have started working on their own versions of it to address components of the project.

  1. Build a shared vision with authorizers and implementers so the cause is owned by every participant without a transactional benefactor and beneficiary relationship
  2. Constant collective learning with the entire team engaged in translating cognition into tangible

reality ever ready to adapt and iterate at a pace that is realistic for the entire team

  • Perseverance, Patience and Empathy are key to building collective accountable leadership

So, after months of weekly meetings (ZOOM) every time I see the progress and the pride that people take in what they are doing and how they have with almost no additional money brought about improvements that nobody had ever attempted or envisioned. Leadership at multiple levels has blossomed and accountability is being taken seriously. It is a good start and I hope in the not too distant future the team brings about the kind of transformation that is of tremendous benefit to their patients and their own community feels gratified. I feel privileged to be part of the process and for me it is more about the journey than the destination.

In summary do not be deterred by apparent complexity and magnitude of what you believe passionately in doing. The problem driven iterative adaptation allows us to be innovative and simply chip away at seemingly insurmountable obstacles. All we need to have is the grit to hang in there and be willing to give it time without prejudging the outcome. What emerges from the effort may simply transcend your initial expectations. When you start seeing how an entire team of people get together and bring about tangible progress you realize how transformational PDIA is!

The IPP course was also a fantastic opportunity to interact with people from all over the world and as I learned about their work, I became a witness to history being made, what the participants in IPP are doing is truly inspirational. Through this project and the IPP course I have had the opportunity to meet so many extraordinary people, and what they make me feel is best described by Secret Garden’s “You raise me up” here is my favorite version by Martin Hurkens: https://youtu.be/4RojlDwD07I

This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. Participants successfully completed this 6-month online learning course in December 2020. These are their learning journey stories.

Learn more about the Implementing Public Policy (IPP) Community of Practice and visit the course website to apply.

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