What if you went on vacation and when you got to your hotel room, you discovered there were no bath towels for you to use during your stay? That scenario is unacceptable. You need bath towels in the room where you’ll be bathing, and you didn’t bring your own. There’s a simple fix - call the front desk and ask them to deliver clean towels. Within a few minutes, a hotel employee will be at your room with the towels.
In a hospital setting, the scenario is much different. Caregivers enter patient rooms and often don’t find all the supplies they need. There is no “front desk” from which to order non-latex gloves, water for the patient’s bedside, or a remote control for the television. Instead, the caregiver has to leave the room to get the items and bring them back. In taking this action, the caregiver has unwittingly added extra steps to his or her process and an opportunity for hand hygiene failure is born.
I recently attended a meeting where the results of a hand hygiene value stream were reported. A multidisciplinary team spent three days studying why hand hygiene failures occur, looking at workflow processes on Unit 48 and trying to make hand hygiene compliance better by improving efficiency at the bedside.
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| Members of GBMC's TCAB Hand Hygiene Value Stream Team |
The team looked at a typical surgical admission scenario and identified 14 opportunities for a single nurse to practice hand hygiene. The 51-minute admission process was affected by a lack of a standard room setup and the need to continually leave the room to get missing supplies, which resulted in more chances for someone to forget to wash their hands. The team learned that hand hygiene compliance is more complicated than just remembering to “wash in, wash out.” Hand hygiene failures are actually the result of poorly designed processes.
So, the group developed standard work for the processes they studied. They standardized forms, created a diagram of how a patient room should look before an admission and made a listing of necessary supplies for each room. These changes, along with several others, will be implemented and tested on Unit 48 over the next few months so that successes can be shared with other units.
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| Non-standardized room |
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| Standardized Room Set-Up |
I was excited to be present at the report out. It shows that we’re taking action to make changes. And I’m proud of the team that participated in this important work: Janet Achiro (U48), Rayna Bush (Transportation), Antonio Crossfield (EVS), Pat Forbes (U48), Ryan Gruver (Performance Improvement), Bridgette King (Hostess), Stephanie Mayoryk (Infection Prevention), Erin McCoy (Nursing Education), Eileen Skaarer (manager U48), Joyce Walters (Phlebotomy) and Jill Wheeler (Nurse Staffing). They were using continuous performance improvement to improve our care and reduce wasted steps for our nursing staff. See my blog posts from April 21, 2011 and February 18, 2011 to re-read the five tenets of continual improvement. Well-designed systems, like the ones being tested on Unit 48, will help us to achieve a high level of reliability to ensure safety and quality.
Do you see “broken” systems in your day-to-day job that need to be fixed in order to improve our reliability for providing safe, quality care? Share your thoughts in the comments section below, or make a suggestion to your manager for his or her monthly Zero Waste idea forms.
Finally, I want to take a moment to remember the lives of two men who helped to make GBMC the outstanding healthcare system it is today. Their generosity was truly inspirational.
William A. Kroh served on several GBMC boards and was also our patient. Mr. Kroh and his wife, Jarnetta, were instrumental in establishing the Kroh Center
William E. Kahlert passed away last week. Also a patient of GBMC, he made one of the largest gifts by a living donor. This allowed GBMC to be at the cutting edge of clinical trials in urology through the organization’s first-ever endowed research chair. The William E. Kahlert Endowment for Urologic Research, led by Ronald Tutrone, MD, supports the research of prostate, bladder and kidney cancers, as well as other urological conditions.
Mr. Kroh and Mr. Kahlert will be deeply missed.
There were no physicians on your improvement team. Many would probably love to lead such initiative but they have no training to do so. They are probably the leading contender for the lack of consistent hand washing as well. I would love to see what metrics you used to measure improvement as well as the level of improvement the solutions you implemented achieved.
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