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!
Eileen and her team will keep working on the design until they get to perfection but what about the rest of GBMC HealthCare? Well, we have to get better at spread. In healthcare we are not as good as we need to be at testing a change, finding out that it works in the test area, and then spreading it to other units. The Hand Hygiene Team is working to spread the Unit 45 design and daily metric to our other inpatient units. I can’t wait to see our improvement over the next few months!
What ideas do you have to help us spread standard work faster?