How to Successfully Introduce a Large-Scale Hand Hygiene Improvement Initiative

By Clean Hands - Safe Hands

Initiating a coordinated hand hygiene improvement initiative in a large healthcare system is not as difficult as you may think.

Certainly, there are challenges involved when introducing any kind of change in an organization with thousands of employees. Healthcare systems that stretch across municipalities, counties, and states face additional obstacles (and opportunities), including diverse cultures and regional regulations.

But successful change is possible on a large-scale. 

According to a 2014 article published in BMC Health Services Research, “effective leadership and clinical champions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in effective successful system-wide change.”

Identify Leaders and Clinical Champions

It’s best to identify leaders and clinical champions before you introduce a hand hygiene initiative to your workforce at large. Think of these people as influencers, akin to today’s social media influencers, who are powerful because other people look up to them. It is essential to get buy-in and committed support from top executives, middle managers, and local clinical leaders. If you are instituting an initiative on a very large scale, you’ll need corporate level leaders as well as leaders and champions at each of your healthcare facilities.

Clean Hands-Safe Hands encourages healthcare organizations to identify:

  • An Executive Champion, who will oversee implementation and provide accountability during the implementation process
  • An Infection Prevention Champion, who will help unit managers launch and support new hand hygiene strategies
  • Unit Leaders, who serve as initiative cheerleaders and boost hand hygiene efforts on their units
  • Coaches, who talk about hand hygiene data and answer questions

Large healthcare systems may need an Executive and Infection Prevention Champion in each facility.

Invest in Adequate Resources

If you’re not willing to invest time and money in your hand hygiene initiative, you’re unlikely to see persistent improvements. 

Of course, smart investment is key. Ideally, you want a hand hygiene system that incorporates and facilitates staff education. Clean Hands-Safe Hands uses a systematic six phase process to drive behavioral change within organizations:

  • Phase 1 – Collection of baseline data
  • Phase 2 – The Natural Language Voice Reminder, which audibly reminds staff to sanitize their hands at appropriate times, is turned on
  • Phase 3 – Gamification and positive reinforcement promote staff engagement with hand hygiene data
  • Phase 4 – Fun, individual competitions promote continued adoption of healthy hand hygiene habits
  • Phase 5 – Workflow process enhancement
  • Phase 6 – Use of real-time data to address high-risk patient situations

Strict adherence to the process leads to success. However, it’s important in a large healthcare organization to allow different units or facilities to work at their own pace. As noted in a 2013 review by the Sax Institute, “large-scale implementation of quality improvement initiatives requires a balance between centralized strategic planning and coordination, and autonomy and empowerment at the local level…”

On-the-ground situations vary, and local leaders need to be able to pause or move forward as clinical reality allows. A hospital experiencing a COVID-19 surge may need to pause at Phase 2 for a while, while its sister hospitals in other states move on to Phase 3.

Executive and local leaders can use Clean Hands-Safe Hands Vital Signs Dashboard to quickly assess staff engagement in the hand hygiene improvement initiative. At a glance, leaders can see how units and facilities are doing on key metrics that contribute to hand hygiene: wearing the badges that detect and log hand hygiene incidents, logging in to check hand hygiene performance, discussing hand hygiene data. If these metrics start to decline, prompt intervention can keep hand hygiene efforts on track.

Plan Dedicated Promotional Activities

Positive reinforcement promotes behavior change better than negative reinforcement. Large health systems that successfully implement hand hygiene initiatives almost always include fun promotional activities, such as the friendly unit- and individual-based competitions that occur during Phases 3 and 4 of Clean Hands-Safe Hands six-phase process.

Remember: health system leaders can use the Vital Signs Dashboard to determine whether to move forward or pause the implementation process. If all metrics look good at a particular facility, it may be time to move forward. If, for instance, badge wearing drops off, running a week-long competition to see which unit or shift can chart the highest percentage of staff members wearing badges may keep your hand hygiene initiative on track. 

Successful large-scale implementation of a hand hygiene improvement initiative is within reach. 


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