Infection Prevention Consulting: Do You Have What it Takes?

It’s a brave new world for infection preventionists who leave the healthcare institution setting to become independent consultants. We asked a few infection prevention consultants for their thoughts on this kind of career evolution; they are:

Gail Bennett, RN, MSN, CIC, ICP Associates, Inc.

Libby Chinnes, RN, BSN, CIC, IC Solutions, LLC

Anita Earl, RN, BSN, IPEC Consultants, Inc.

Phenelle Segal, RN, CIC, Infection Control Consulting Services

Linda L. Spaulding, RNC, CIC, InCo and Associates International, Inc.

Not everyone has what it takes to become an infection prevention consultant, so what do you believe are the qualities needed for success?

Bennett: First of all, consultants need knowledge, skills and experience in their area of consultation. We are being hired to provide information, innovation, efficiency, objectivity and sometimes technology to assist our clients with infection prevention. Therefore, we must be able to deliver what is required by the client. In addition, regardless of the type of educational preparation the consultant has, he/she needs to be certified in infection control. I believe in today’s environment our clients as well as our employers, consider certification to be mandatory and it certainly shows that we have at least a minimal knowledge level in our field. Some of the skills that I consider most important for the consultant include the ability to analyze, organize, speak clearly and confidently, write clearly and effectively market the available services. Additional skills needed include basic accounting, scheduling, and time management. Consultants need to be willing to hire “consultants for the consultant.” For example, an accountant that serves small businesses, an attorney, an office manager, etc. as needed. Some of the greatest operational challenges have to do with initially not having the complete skill set to be effective and efficient. It takes time to learn the business aspects of starting and running a business when many of us have primary skills in providing healthcare.

Chinnes: Qualities needed include critical thinking skills; being able to apply basic concepts on infection prevention and control to multiple settings and complex situations; being hard-working at oddball hours at times; persistence and drive to make a difference in patient care; and being flexible — taking some assignments you don’t like for the learning experience and because your mother told you that “eating broccoli would make you stronger!”

Earl: In addition to significant infection prevention experience and credentials, current evidence-based knowledge is a hallmark. The qualities of excellent communication and people skills are very important in order to cultivate a collaborative relationship with individuals in the organization resulting in a successful project.

Segal: Ambition, entrepreneurial spirit, inner strength, motivation, fearlessness, determination to succeed, emotional and financial ability to stay afloat if and when business is waning (usually temporary depending on type of consulting chosen), optimism and realism.

Spaulding: First, if you don’t love infection control, don’t become self-employed. To be successful you must love what you are doing. I think the qualities that are needed are flexibility; you have to love change; you need to be able to separate fact from fiction and deal only with fact; and you must be willing to work harder than you ever did for an employer. Being self-employed is a 24/7 job to be successful. There are days when you get little sleep because your clients need something yesterday.

What are the operational challenges that face a potential consultant?

Bennett: There are many rewards to having a consulting business. They include: flexibility in the type of services you wish to provide as well as flexibility in scheduling; financial rewards (the sky is the limit based on how hard you want to work); ability to be creative; a sense of great accomplishment in helping your clients to meet their goals; and you’re the boss! It does not get any better than that! I enjoy all of those things and the opportunity to meet and work with so many great people, especially the infection preventionists out in the trenches improving quality one day at a time.

Chinnes: Have an accountant, lawyer and business mentor you can call when needed. You may not need them much, at times; but when you do, these trusted advisors are essential to your business. All business is not good business; learn and move on. Don’t spend 100 hours on a project for which the client is only willing to pay 10 hours — it’s not worth it! Put aside any extra income that you can, especially in these economic times. A wonderful first quarter does not ensure a great rest of the year. Diversify and be willing to take your knowledge to new areas: airlines, industry, day care, etc.

Earl: Perhaps the best approach when considering a new business is to start on a small scale. The first step is to create a business plan outlining the scope and services of your potential consulting business. Since a consulting business is a service industry and classified as a small business under the Internal Revenue Service, the company should be legally registered in the state where it is established. Determination needs to be made regarding the business organizational structure by conferring with an attorney and accountant. Many decisions should be made regarding financial considerations such as insurance coverage, expenses related to start up costs, maintenance/office expenses, reserves for taxes and establishing a separate bank account. Meticulous bookkeeping is a must.

Segal: Business and marketing skills can be a challenge, particularly for clinical persons entering the business world. Consultants usually face financial start-up challenges too, and organizational skills which are different from the clinical setting can be challenging as well. In addition, one has to constantly be looking for “the next contract” or business opportunity, as consulting work can ebb and flow.

Spaulding: Accounting, keeping your own books and getting your invoices out on time so you get paid can be a challenge. First, hire an accountant to do your taxes but do your own billing, pay your own bills and keep track of your own money. I’d never turn my money over to someone to handle. It’s important to utilize computer programs to your advantage. Develop forms that you can use to make you job easier. Health insurance can be a challenge. Getting and paying for insurance on your own is eye-opening. Do your homework before jumping ship from your full-time job. I started my business while still working part-time in order to pay the bills. Once you get busy enough you will know when it’s time work full-time for yourself.

What are the rewards of being on your own?

Bennett: I would tell infection preventionists who want to do consulting to go for it but plan carefully. Someone starting their own business should have enough money to support themselves and the business for a two-year period. That can be accomplished by existing savings or a loan. You may be able to get a low-interest loan for a minority business owner, funds from a venture capitalist, or other means. Develop a business plan. There are a variety of software programs that make this relatively easy. The plan will help you make important decisions about your business that will guide your start-up and the early years. Become part of a network that can assist you. The National Nurses in Business Association (NNBA) is a good organization that provides educational opportunities and will put information about you on their web site with a link to your email. Get involved with the consultant’s focus group sponsored by APIC each year at the national conference. We all have a lot to share and we can support each other.

Chinnes: We truly have such an important role to play in helping patients and employees alike in prevention of spread of disease. Maybe our teaching of the application of these well worn principles may protect one of our loved ones one day! Also, it means less politics as well as independence and freedom to work on many projects at once. I love to travel and see how others are implementing positive changes.

Earl: Many benefits balance with the risks of running a business. Flexibility of your own schedule is a key benefit, which can impact on the quality of one’s life. However, self-discipline and time management are essential qualities in order to have a successful business. The professional rewards are great for those of us that have such a passion for infection control and prevention!

Segal: Maintaining autonomy and control of the operations (do not report to a higher authority and set own goals); a flexible schedule (set your own hours); the privilege to choose or decline clients; the financial reward (depending on how driven one is to succeed); and a strong sense of self-accomplishment (when one builds a good reputation, one’s self worth and self confidence rises exponentially).

Spaulding: For me I’m a much happier person being self-employed. As a consultant people are asking you to come in and help them fix a problem that they have identified and they are very willing to listen to what you have to say. I have the opportunity to get more experience in many areas of infection control so every day is a new experience and probably in a new city or state. It’s great meeting new clients everyone is unique. It’s nice to see what a facility can accomplish when I’ve been able to give them the right tools.

Any advice you can impart to infection preventionists considering their own ventures?

Earl: When starting out on this venture, seek out other infection prevention consultants to find out how they started and how to build a consulting business. Determine your fee for service schedule and do a risk-benefit analysis. Consulting strategies largely determines success by how to market your services. Begin by setting up a Web site.

Segal: If you are at the point of considering your own venture, you are half way there. Be sure that this is what you want to do as a half-hearted interest will not be advantageous. Your first major step is to have a written business plan. Most businesses collapse when a fully fledged business plan is absent. You have to give it all you have, be prepared to face many challenges and rely on experts and mentors to guide you. Understand that there will be days that you want to quit and go back “to the womb” for protection, but perseverance in the presence of a good plan, well sought after service and your personal ambition should assist you in being successful. If the business grows and you are not able to cope, consider hiring sub-contractors to relieve you of the workload.

Spaulding: Be sure to keep up with the latest information and stick to the facts — don’t get pulled into the hype of a situation. Be clear and concise with the information you give and be sure your clients under the information you’re providing. Become good at networking.

What are the issues that still seem to plague client hospitals these days? Anything new you’ve seen lately?

Earl: Contracting to perform services within the acute healthcare setting involve many issues such as strategies to reduce and eliminate MDROs, outbreak investigations and support, state and federal compliance and accreditation, review of policies and procedures, and review of infection prevention and control programs in preparation for a Joint Commission survey. Review considerations regarding the effectiveness of the program include efficiency assessment, effective use of data and assessing the entire system for practice compliance as integral components to overall patient safety and cost reduction. Many opportunities for consulting occur outside hospital facilities such as the ambulatory care settings, especially surgery centers. Increasing needs continue to be identified in long-term care settings. Additionally, recent H1N1 flu concerns are providing new opportunities for infection prevention consultants to provide services for not only various healthcare facilities, but can also serve as an educational resource to the community. Complex invasive procedures and technologies are no longer limited to acute healthcare facilities. Since invasive procedures occur in a variety of healthcare settings, this opens the door for additional consulting opportunities. Infection preventionists (IPs) are challenged to institute infection prevention strategies in new practice settings where there may be insufficient evidence based infection reduction information. Increased focus on instrument and medical device reprocessing needs in the ambulatory care settings provide great consulting opportunities. In the hospital environment, the ever increasing legislation and regulation that impacts on generating more infection data to be reported is a significant added stress on the infection control staff. Currently, infection prevention and control departments throughout the country are losing valuable staffing and resources that are desperately needed. IP staff are asked to do more with reduced staffing or not allowed to increase staffing. Many IP programs are also experiencing reduced funding for education. Definitely more consulting opportunities are becoming available because infection preventionists are leaving their positions. In fact, some hospitals are faced with no IP on staff. Consultants are frequently called in to meet these needs.

Segal: Infection control challenges in hospitals remain in terms of the need for additional trained staff to do a specialized job. In addition, fiscal resources need to be increased overall in the hospital setting so that best practices can be adequately carried out for the benefit of the safety of patients. Many hospitals still struggle with providing enough financial support for programs that will enhance patient safety.

Spaulding: It depends on what part of the country you are talking about. Smaller cities still struggle with simple surveillance. I still see facilities assign the title of infection control practitioner (ICP) to a nurse but not prove any education to them. So they do the best they can without any education or resources. The biggest issues right now is dealing with the pandemic. Some hospitals may not be taking this serious and others have assigned individuals other than ICPs to run pandemic preparedness.