Sustainable Change for Healthcare Hand Hygiene is a Process

By Madison Pittman

If achieving excellent hand hygiene rates resulted from simply purchasing and installing an electronic monitoring system, every hospital in America would already own a high-tech system. The upfront investment would quickly be offset by decreased healthcare-associated infections (HAIs). 

But technology alone cannot solve hand hygiene challenges. Early on we learned that just throwing technology at a human problem does not work. Human beings are notoriously resistant to change, as humans require a relatively stable environment to thrive. That’s one reason why many changes in organizations fail to achieve desired goals. According to a 2020 article published in BMC Health Services Research, organizational change has an approximately 70% failure rate. 

You can increase your organization’s chances of success by utilizing a systemic process that taps into human needs and desires.

Case Study: Peter Pronovost and CLABSI Reduction

Over the past 15 years, central line-associated bloodstream infections (CLABSIs) have decreased by more than 80% in United States intensive care units, thanks largely to the efforts of Peter Pronovost, MD, PhD, then a professor of anesthesiology and critical care medicine at Johns Hopkins University, and thousands of other dedicated researchers and clinicians. 

Pronovost developed a checklist that included all the steps necessary to avoid central line infections. When he introduced it at Johns Hopkins and asked medical staff to run through it each time they inserted a line, CLABSIs decreased from 11% to zero. 

The checklist was then piloted and tested in Michigan, where its use again led to significant decreases in infection. Since then, checklist-based CLABSI prevention efforts have evolved to include unit-based safety programs, and as the use of CLABSI checklists and safety programs have spread throughout the country, CLABSI rates plummeted. 

In a 2016 BMJ Quality & Safety article reflecting on the success of CLABSI reduction efforts, Pronovost noted the importance of a systematic approach to reducing healthcare harms. 

A Six-Phase Process to Improve Hand Hygiene Performance

Similarly, Clean Hands-Safe Hands uses a systematic six phase process to drive behavioral change:

Phase 1

Phase 1 involves collection of baseline data without any type of feedback – an important step according to Pronovost, who noted in 2009 that “we are grossly overconfident about how good we are.” Valid measurements are a crucial first step to meaningful change.

Phase 2

During phase 2, Clean Hands-Safe Hands Natural Language Voice Reminder is turned on. If clinicians fail to clean their hands when entering or exiting a patient room, a gentle voice reminds them to sanitize their hands. During this phase, providers are asked, “When do you hear a voice when you shouldn’t?”, which leads to opportunities to assess providers’ understanding of hand hygiene protocols. This phase gives managers an opportunity to educate staff regarding best practices and underscore the benefits of improved hand hygiene. That’s important because research has found that healthcare professionals are more likely to “buy into” organizational changes that clearly benefit patients.

Phase 3

Phase 3 uses gamification and positive reinforcement to promote team engagement with the data. The Agency for Healthcare Research and Quality (AHRQ) notes that staff engagement is crucial for effective change in healthcare settings. 

Phase 4

During phase 4, we use an individual competition to highlight top performers to uncover their “secrets of success” and use their feedback to help other staff members. Competition and recognition shift from team- to individual-focused. These actions support staff autonomy and promote continued engagement.

Phase 5

Phase 5 focuses on workflow process enhancement.  During this phase, Clean Hands – Safe Hands uses proprietary algorithms to identify specific providers whose workflow patterns are preventing them from improving their hand hygiene practices. By leveraging the data systematically, the clinical leaders can identify and minimize practical barriers – another AHRQ-recommended step for the implementation of best practices. 

Phase 6

In phase 6, we help organizations tackle high-risk patient situations by analyzing hand hygiene data in real-time. The Clean Hands – Safe Hands system uses an algorithm to predict clinical situations that are at unusually high risk for spreading HAIs. We can then notify the clinical leaders in real time so they can intervene before there is a chance to spread the infection. 

The Results

Hospitals that have implemented Clean Hands-Safe Hands six-phase process have more than doubled hand hygiene performance rates and cut HAIs by 65% — and sustained those positive changes over time.

“Our process helps clients achieve real, lasting, and meaningful change,” says Chris Hermann, MD, PhD, founder and CEO of Clean Hands-Safe Hands. 

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