Healthcare Hygiene magazine November 2019 | Page 34

hand hygiene By Paul Alper A Checklist to Drive Higher Compliance: Using Actionable Feedback to Drive Meaningful Change I ’m often asked a simple question by healthcare organiza- tions: “We are not ready to change products or put in an electronic monitoring system yet – but we do want to use evidence-based practices to drive improvement with what we have in place today.” Giving that some thought, I’ve put together a checklist based on an actionable feedback model that should help you make some changes in the way your organization thinks about hand hygiene compliance, its safety culture and the social fabric of your community. The following checklist is based on insights and inspiration gained from some interesting studies 1-3 basic PDSA cycles thinking, and my 35-plus years of working in many aspects of hand hygiene and patient safety innovation. Here’s the list: ➊ Make hand hygiene compliance a unit/ward/department responsibility. Hand hygiene compliance improvement should be a defined responsibility at the unit level with the manager responsible and accountable for meeting growth targets. 1 A great way to help ensure results is to tie this directly to the performance appraisal process. ➋ Identify the unit-specific barriers and obstacles to hand hygiene behavior plus action plans to remove Them. Each unit becomes responsible for identifying its unique barriers and obstacles to hand hygiene compliance and putting in place specific action plans to remove them. 1 This might be best accomplished using direct observation to capture those unit specific behaviors that need to be modified. 2 ➌ Establish unit-specific improvement goals. Each unit is responsible for establishing its own realistic improvement goals monthly, which should be achievable assuming the action plans are carried out as assigned. 1 The end game is that the barriers and obstacles identified can be continuously reduced or eliminated. ➍ Measure performance and give routine feedback consistently. Use the most robust approach to measure- ment available to your organization within the resource constraints (time, people, money) and provide performance feedback on a consistent basis (weekly to start, migrating to monthly, for example). Be sure to measure the behavior standard that you train staff on – in/out, WHO 5 Moments, CDC or a variant you’ve chosen for your organization. If the approach is electronic monitoring, ensure its accuracy has been validated. If you’re using direct observation, be sure you control for inter-rater reliability. A quick thought about secret shoppers: It’s difficult to comprehend why an organization would witness the potential risk of not cleaning hands without intervening. ➎ Celebrate successes and then set a new, higher goal. When goals are not met, have the same barrier/obstacle/ action plan conversation. 34 ➏ Make psychological safety a cultural norm. Anyone at any level within the organization can remind anyone else regardless of their level or status when hand hygiene is missed in a professional, “out of patient view” way, without the fear of reprisal. ➐ Make leaders responsible for modeling and authentic engagement. C-suite leaders must know about, support and model the behaviors expected across the entire staff community. In one of the studies on which the checklist is based on, Childers, et al. used this basic framework at Memorial Sloan-Kettering Cancer Center, and a baseline rate of hand hygiene of 60-70 percent increased to 97 percent as measured with direct observation. 1 Kelly, et al. also used a similar approach with electronic monitoring for measurement at the Greenville Memorial Hospital and achieved a 25 percent increase in hand hygiene compliance with a 43 percent reduction in MRSA infections. 3 Steed, et al. also used a variant at the same organization combining modified use of the Joint Commission’s Targeted Solutions Tool with electronic monitoring for measurement and achieved aggregate performance increase on four test units of 23.5 percent within six months that was statistically significant. 2 To be clear, we are a long way from “getting hand hygiene right” – this is just one framework that requires no investment other than time that might make sense to consider in some adapted embodiment that aligns well with your culture and organization. A three- to four-unit pilot will help you see if it works for you. Let me know what you think, and please send me your specific hand hygiene challenges, frustrations and nagging problems – I’ll share any ideas that might be of interest and help in this monthly column [email protected]. Paul Alper, BA, led the launch of PURELL®, invented the first electronic hand hygiene monitoring system proven to reduce infections while improving behavior and eliminating costs, and is now the vice president of patient safety innovation for Medline Industries, Inc. through an exclusive engagement with his consulting practice, Next Level Strategies, LLC. References: 1. Son C, Chuck T, et al. Practically speaking: Rethinking hand hygiene improvement programs in health care settings. Am J Infect Control. 39(9), 716–724. 2011. 2. Kelly W, Blackhurst D, et al. Use of the Targeted Solutions Tool and Electronic Monitoring to Improve Hand Hygiene Compliance. Paper Present- ed at the 2016 SHEA Conference. 3. Kelly W, Blackhurst D, McAtee W and Steed C. Electronic Hand Hygiene Monitoring as a Tool for Reducing Healthcare-Associated Methi- cillin-Resistant Staphylococcus aureus Infection. Am J Infect Control. 44(8), 956-957. 2016. november 2019 • www.healthcarehygienemagazine.com