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An organizational perspective on hand hygiene: a model for building to success

This article discusses a model for improving hand hygiene compliance from an organizational perspective. It explores the role of leadership commitment, management structures and processes, and clinical process redesign in implementing evidence-based clinical practices. The article also provides a case study of a Veterans Integrated Health Care System that successfully improved hand hygiene compliance through a systematic quality improvement approach.

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An organizational perspective on hand hygiene: a model for building to success

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  1. An organizational perspective on hand hygiene: a model for building to success Carol VanDeusen Lukas, EdD Center for Organization, Leadership and Management Research Department of Veterans Affairs April 10, 2008

  2. Background • Project in the Department of Veterans Affairs resulting from collaboration of: • Directors and Chief Medical Officers of three Veterans Integrated Health Care Systems • Center for Organization, Leadership and Management Research • Lessons from Robert Wood Johnson Pursuing Perfection (P2) shaped project approach

  3. Project aim • To improve hand-hygiene compliance using a three-pronged model to strengthen the organization’s ability to implement evidence-based clinical practices

  4. Organizational infrastructure Active top leadership commitment Links to senior management structures and processes Improved evidence-based clinical practices Organizational model for improving evidence-based clinical practices Clinical process redesign

  5. Clinical process redesign … • Actively engages middle & front-line staff around priority clinical issue • Works toward desired hand-hygiene performance through system redesign to build new practices into daily work • Builds skills, motivation and culture to support and sustain quality improvement • Experience with systematic quality improvement and redesign teams • Confidence to tackle other problems

  6. Redesign key actors, venues: • Infection control professionals • Hand-hygiene champions • Multi-disciplinary redesign teams • Collaborative, interdisciplinary work, including MDs • Systematic problem analysis, data collection, tests of change • Shared learning groups

  7. Redesign activities: • Education and awareness – what needs to be done • Product selection and placement – make it easy to do • Social marketing – create imperative to change • Monitoring and feedback – feedback on how doing

  8. Active top leadership commitment... • Sets priorities for the organization • Establishes hand-hygiene as high priority • Sets high expectations for performance • Communicates commitment & goals • Demonstrates personal commitment through use of own time • To quality in general • To hand hygiene in particular

  9. Leadership commitment actions: • Set public goal for breakthrough performance in hand hygiene • Model good hand-hygiene • Talk with patients and staff about hand hygiene on leadership rounds • Discuss hand-hygiene at employee forums • Attend performance improvement or other quality committees

  10. Management structures & processes… • Align redesign efforts with organization’s strategies and priorities (top to bottom) • Actively support redesign with needed resources • Create accountability through measures, reporting and monitoring progress • Integrate activities across organizational boundaries (facilities, workgroups, functions) • Facilitate cooperation and problem resolution • Spread learning and reinforce culture

  11. Management structure & process actions: • Identify cabinet champion or executive sponsor to work with redesign efforts • Monitor hand-hygiene performance at leadership meetings • Hold low-performing areas accountable for improvement • Leverage cooperation across professions and departments • Provide resources to recognize and reward success

  12. High-level performance builds from all three elements: a VA example • High-performing academic medical center with wide experience in systematic quality improvement • Well-established redesign team for hand-hygiene with strong leadership commitment and management processes and support • Hand-hygiene compliance ~80%

  13. Urgency takes to a new level: VA example continued • Hand hygiene cited as problem in Joint Commission Survey • 30 days to reach 90% • Blitz built on strong base • Redesign team coordinated education, awareness, generation of new ideas from all areas • Data collection increased • Middle-managers held accountable • Chief of staff very active in holding physicians accountable • Reached, then exceeded 90%

  14. Sustaining improvement • Aim to move from special project needing extensive attention to routine business, built into culture • But need periodic monitoring to sustain; hold accountable and take action if performance drops off

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