Hand Hygiene: Move Beyond Measurement and Nurture Change

By Clean Hands - Safe Hands

Weighing a chicken doesn’t make it fatter.

That piece of wisdom comes from William Bornstein, MD, PhD, Chief Medical Officer and Chief Quality and Patient Safety Officer for Emory Healthcare.

It might seem strange for a medical doctor to “weigh in” (pun intended!) on poultry farming, but Dr. Bornstein was trying to make a point: monitoring and measuring data will not lead to significant change. Measurements simply document change and indicate positive, negative, or stalled progress toward an end goal. That truth applies to agriculture, healthcare, industry, and education. 

Measuring and documenting the amount of feed an animal eats weekly and charting its weight gain is not enough to help the animal grow. Measuring and documenting standardized achievement test scores does not improve student reading ability. And measuring soap and alcohol-based hand rub usage and charting hand hygiene compliance is not sufficient to improve hand hygiene or decrease healthcare-associated infections (HAIs). 

As any poultry farmer will tell you, chickens need water, safety, and appropriate feed (in appropriate amounts) to grow. Educators constantly remind us that standardized tests are not a good indicator of student learning, and that a myopic focus on test scores has caused many schools to cut back on recess time, free play, and student-driven exploration, even though those activities are positively linked to student learning. 

Healthcare is no different. Clinicians and healthcare leaders who want their patients and staff to thrive must move beyond mere measurement to nurture meaningful change. 

Monitoring Hand Hygiene Won’t Decrease HAIs

The current Leapfrog Hand Hygiene Standard requires hospitals to collect hand hygiene compliance data on at least 200 (or 1.7% of all possible) hand hygiene opportunities each month, in every patient unit. However, “just monitoring hand hygiene is pretty much a waste of time, money, and energy,” says Chris Hermann, MD, PhD, CEO of Clean Hands-Safe Hands.

That’s why the Leapfrog standards also require hospitals to provide hand hygiene training to staff and easily accessible alcohol-based hand rub. The standards demand collection, documentation, and regular analysis and discussion of hand hygiene data because awareness is the first step toward change. (And because these metrics reflect progress toward safety initiatives.) 

Chickens (and People) Require Care

A farmer who is raising chickens for market knows that the animals need a comfortable, safe environment to reach their full potential. Successful farmers create conditions that allow their chickens to thrive. The most successful farmers rely on proven processes to nurture chicks to adulthood. 

Nurturing environments and proven processes can help healthcare personnel deliver consistently excellent care as well. Without sustainable processes and support, too many safety initiatives fall by the wayside. 

“The whole purpose and focus of our system is improving – not simply monitoring – hand hygiene,” Hermann says. “That starts with our Natural Language Voice Reminder and includes our Hand Hygiene Acceleration Pathway process, as well as our Real-Time Intervention Blueprints and Vital Signs Dashboard, which alert frontline leaders as problems occur so they can intervene.”

Weighing a chicken won’t make it fatter, but automatic verbal reminders that nudge farmhands to feed the chickens at the appropriate times can support weight gain. Real-time data that reflects which animals are showing up at the feeders (and which are not) can direct farmers’ attention to birds that may be ill and need extra attention, so the farmer can provide medical support and extra nutritional intervention, if needed, to keep the animals’ growth on track. 

Similarly, electronic hand hygiene systems that remind healthcare staff to sanitize their hands at appropriate times and include actionable, real-time analysis are far more likely to lead to sustained improvements in hand hygiene (and decreased HAIs) than systems that simply monitor hand hygiene compliance. 

Weighing a chicken won’t make it fatter, and monitoring hand hygiene won’t improve hand hygiene or decrease HAIs. Additional support is needed to nurture change. 


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