How Did We Improve Our Hand Hygiene Rates?

I arrived at GBMC in the summer of 2010 shortly after we received our first “secret shopper” measurement of hand hygiene and learned that it was a toss-up if someone coming into your daughter’s room at GBMC had washed his or her hands before entering. I remember thinking that it wasn’t that people didn’t know to wash their hands nor was it that they didn’t care. The rate was only about 50% because people’s minds were elsewhere…they were busy or they were distracted. I wondered how we would ever get closer to clean hands every time? I couldn’t think of a design change that was likely to work.
 
We tried the “technology” route in the MICU. We worked with a vendor that had software that would measure the rate and prompt the individual. We ended the test concluding that the MICU rate was no better than rates without the technology. We started to get traction when units started doing audits on a few trips in and out of a room on a daily basis. It seems that the staff doing audits generated better engagement and it started to lock in the habit.

Our run chart of hand hygiene compliance is one of the best examples of healthcare improvement that I have ever seen. I am still reflecting on the drivers of this change so I asked some GBMC colleagues. More awareness and people looking out for each other…measuring on a unit LDM board…extra focus…spreading knowledge about hand hygiene….culture change…the realization that we were not washing our hands….making it more personal for you…. turning handwashing into a fun game….calling it out among colleagues….these are the reasons my colleagues listed for this great improvement. The rate of almost every hospital acquired infection that we measure has been reduced as our hands have been getting cleaner. I am very grateful to all of my GBMC colleagues for this improvement work.
 
I would love to hear your ideas on how we accomplished this because it is in learning what works that we can make more improvements faster!

Gilchrist Hospice Care and Gilchrist Greater Living continue their spectacular work in leading the region in compassionate, evidence-based care to seniors and those at the end of life. I applaud all the hard work that Gilchrist Hospice has done over the years to help so many individuals and families through the end of life. Gilchrist not only provides world class medical care to patients in their final days, but they also provide emotional and spiritual support.  In the past 20 years, Gilchrist Hospice Care has cared for over 40,000 patients and approximately 100,000 loved ones.
 
Please come and show your support for Gilchrist’s work by attending the Holly Ball this Friday, Dec. 12 at the Baltimore Marriott Waterfront.  This year’s black-tie event, which starts at 7:00 p.m., will benefit the Gilchrist Towson inpatient center. For more information on the Holly Ball, please go to http://gilchristhospice.org/hollyball . I hope to see you there!
 
Wishing all those who celebrate the Festival of Lights next week a very Happy Hanukkah!

Delivering on Our Vision

Wednesday of this week was a very big day for GBMC. We celebrated the opening of the new office of Family Care Associates. We began at 8AM. All GBMC staff were welcomed to tour the site on the ground floor of the North Pavilion. I hosted the Baltimore County Business Advisory Council and my colleagues were quite impressed. They couldn’t believe that there was no patient waiting room and they loved the idea of the “flow station” where the physician and medical assistant worked together to improve communication. The two physician leads, Dr. Sarah Whiteford and Dr. Ben Hand gave us a brief presentation on the patient centered medical home and how they had designed this new office to be able to efficiently care for patients. (See my blog on the 3p process that the team used in designing their new home: What would your ideal primary care office look like? http://ahealthydialogue.blogspot.com/2013/12/what-would-your-ideal-primary-care.html).

At 10 AM, the media arrived. We had reporters from a number of newspapers and television stations. We were covered on the evening news on both channels WMAR and WBAL. On Thursday morning, the story was on the front page of the Baltimore Sun!

In the afternoon we welcomed colleagues from Kansas City and Mississippi who were interested in seeing how the office was designed. All were impressed with what the team had built and with how it was being used. Chris Backous, the facilitator from the Virginia Mason Institute, who had helped the team in the design phase, flew from Seattle for the big day. In the evening, we unveiled the plaque honoring Jim and Jacqueline Stradtner and their family. Jim is the Chair of our Board Strategic Planning Committee and has been a force in helping to develop our vision back in 2010 and in holding us accountable to deliver on it. The Stradtner’s made a significant donation to help build the office. We are very grateful for the Stradtner’s’ gifts of both time and treasure.

What impressed me the most were the smiles on all of the staff of the office. From Drs. Whiteford and Hand, to their colleagues Drs. Jillian Klaucke, Dr. JoAnne Wills, Dr. Kathleen Mathey, and Dr. Courtenay Morrow, to Jeanne Gayle the practice manager, Anne Conrad the care manager and all of the medical assistants, and patient service assistants…everyone was proud of what they had accomplished and delighted to be part of a big team that was delivering patient-centered advanced primary care- the care that you would want for your own loved ones and certainly what I want for my loved ones!

I want to thank Drs. Whiteford, Hand and all of their team. I also want to thank Ben Beres, our Vice President for Physician Practice Management and Danielle Da Silva, the Ambulatory Service Line Administrator for working so hard to make this a reality. Many are now talking about patient-centeredness but GBMC is delivering it.