It has been a number of
years since healthcare organizations started working on hand hygiene as a way
to reduce the spread of infections. We have made some progress, but many
outsiders have gotten frustrated with our inability to “just do it” and make “washing
in” and “washing out” the rule.
At GBMC, we have
improved significantly in this area but we still have defect rates of around 20
percent. It is hard to get closer to perfection on this one. But we have gotten
beyond lamenting the reasons why we can’t do it. As I said in the blog a few weeks
ago, we are getting better at improvement.
We know that winning
organizations don’t rely on hard work and good intentions alone. They design
systems to get to the results that they want. Once the system is designed by
the people in it, they follow the design… it’s called standard work.
Standard work gets us to much higher reliability and much lower defect rates.
Teams that create standard work use daily measurement to see how well the
design is operating and to reinforce its use. Brief daily conversations about
how the design is working also help people see further improvements.
Eileen Skaarer, RN, the Clinical Manager on Unit 45, has been
leading her team in the creation of a design to get to better hand cleansing
results. They have been doing a quick audit, by a different staff member daily,
of their hand hygiene compliance. Twice each day, 5 observations are done of
people entering and exiting a room and the results are put on a graph at the
nursing station. When a team member is observed to have not washed on the way
in or out, the auditor reminds the person of the necessity of washing. The
person who did not wash gives the reason why they did not and this is also
recorded for learning on a Pareto chart. When the person did wash
in and wash out, he or she is congratulated. At the daily huddle, the
previous day’s results are reviewed with the team.
The chart below shows the Unit’s
improvement over time when measured by a secret observer. You can
see that in July, the nursing defect rate was zero!
What ideas do you have to help us
spread standard work faster?
Great to see the internal data being published. Good to see both the results and the open communication. Well done on both.
ReplyDeleteI would have to say that I have not been to a hospital that is as pro active in hand washing.
ReplyDeleteI have spent untold hours at your hospital since November 2010.
I brought my friend there with what turned out to be a ruptured appendix and perforated colon. As I sat next to him waiting for results and an open OR, I was struck by the fact that the sink for doctors and nurses and techs was directly across from his bed.
Never, ever, anywhere have I witnessed the continues use of soap and water, At one point a Doctor rushing in, he stopped and washed his hands, as did the team preparing to move my friend to the operating room. The Doctor took a few steps into the room, came to a complete stop and excused himself to wash his hands. I assured him that I had witnessed the act. He thought for a second and said, " If you don't mind I'll only be a minute. If it was an automatic action that I can't remember I'll just put my mind at ease.
I have to pass several hospitals, some just minutes away from my home to receive the type of care I cannot find anywhere, except your hospital.
I might also add that the care my friend received on the 5th floor saved his life many times after the surgery.
At times, when he had a few set backs, the lights were on, the door was open and everyone on that shift was fully aware of the constant attention he needed.
It was as if he were in the ICU, and in keeping with the article at hand, not one time , either coming or going was the hand washing overlooked. They watched me with kindness and understanding but scooted me right back out into the hall if I forgot
.
I have since spent time with the group of angels in the oncology and radiation department.
There is overwhelming attention paid to hand washing and sanitation.
Dr Blumberg and his entire team made me feel as if I were the only and most important patient.
Since my time there, I have read that many newly diagnosed cancer patients lose the first of battles, not from the cancer, but from the lack of affection from family and friends.
I would have fallen into that group had it not been for them. They became my family, they became my support.
After each session I left the building smiling.
I found there the warm feelings of genuine caring .
Thank you for the chance to share my appreciation.
Mary Jones