If you want excellent performance, you need data that can be attributed to an individual. This applies to many areas across healthcare improvement not just hand hygiene.
Group interventions and aggregate reports are a great place to start, but they can only take you so far. In fact, Clean Hands – Safe Hands data shows that most organizations can achieve approximately 60% hand hygiene performance by only using facility-wide initiatives and group interventions. And while 60% is significantly better than the national average of 40-50%, it’s far below the hand hygiene rate most infection preventionists and healthcare administrators would like to see.
Moving beyond the slightly-better-than-average mark requires a dive into individual data. A 2015 review of hand hygiene at eight hospitals in the United States discovered 41 different causes of low hand hygiene performance, which researchers categorized into 24 distinct groups. Researchers and project participants quickly realized that “all the specific causes of hand hygiene failure would require separate and distinct interventions to remediate” – and that each hospital had its own unique mix of contributing causes.
The hospitals that identified and targeted specific and unique causes of poor hand hygiene collectively improved their performance rates by 70.5% and sustained this level improvement for nearly a year.
Researchers involved in the 2015 review concluded that “a single, ‘one-size-fits-all’ approach to improving hand hygiene in hospitals will not succeed [because] if one does not know exactly why hand hygiene is failing and which specific causes are more prevalent … it will not be possible to devise an effective set of interventions.” Further, they wrote that “following a prespecified laundry list of interventions in a particular hospital is likely to result in a significant amount of wasted effort … targeting interventions to specific causes may be more efficient … because it permits hospitals to avoid wasting resources on problems that they do not have.”
Additional research has confirmed that effective interventions can only be developed after first identifying the prevalence of the desired behavior and determinants of that behavior. Only when you understand why someone is (or is not) doing something can you begin to map a path toward desired behavior.
Data from multiple hospitals reveals that “there are a small number of people who make up a disproportionate amount of missed hand hygiene episodes,” says Chris Hermann, MD, PhD, founder and CEO of Clean Hands – Safe Hands. For most organizations a small portion of their staff account for a large chunk of all missed hand hygiene opportunities.
Just as one F on a test call pull down an A-average, one provider with poor hand hygiene habits can pull down hand hygiene rates for an entire unit. In most cases these individuals not only have lower performance, they typically go in out of the patient rooms most often.
Educating — and re-educating — the entire staff won’t be nearly as effective in increasing hygiene performance as identifying and working with the provider who is pulling down the average.
In fact, interventions targeting the whole staff — most of whom are likely already following best practices — may hinder professional development and contribute to employee dissatisfaction. Who wants to sit through another hand hygiene class if they’re already consistently cleaning their hands? Providers who have mastered hand hygiene benefit most from quick, periodic reminders — and professional development time to hone additional skills.
The challenge is that traditional approaches with direct observation make it difficult to easily identify which providers are struggling with hand hygiene. Identifying low performing providers is typically not as intuitive as one might expect. Interestingly, some of the best clinicians are at the higher end of the infection risk spectrum as they are the ones who check on their patients most frequently.
An electronic hand hygiene reminder system that captures and records individual data is the most efficient way to identify outliers. One of the most valuable ways to do this is with Clean Hands – Safe Hands Performance Bubble Plots™. Each circle (“bubble”)represents data from a specific provider for a week. The size of the bubble represents the number of hand hygiene opportunities for that provider over one month, and the color of the bubble represents their hand hygiene performance. Dark green is good; dark red means there’s room for improvement.
Because Performance Bubble Plots are visual, managers can spot outliers at a glance. Often, a quick conversation and some personalized instruction are all that’s necessary to increase hand hygiene. Performance Bubble Plots™ take this a step further and not only identify which providers need a bit more coaching but also identify why they are struggling.
When one manager sat down with a provider with low hand hygiene performance. The CHSH system predicted there was an educational issues and the manager learned the provider didn’t fully understand the hospital’s hygiene policy. She educated the employee about the proper use of gloves. A month later, the provider’s hand hygiene rate improved by 57% — from 30% to 70%.
We also commonly see that many of the barriers to hand hygiene are caused by basic workflow inefficiencies. These barriers are highly specific to individuals and by leveraging the power of big data you can find easily solutions to these otherwise hidden problems.
Acting on individual data can help you effectively and efficiently increase hand hygiene performance,decrease healthcare-associated infections, and improve many many other areas of patient safety.
