IMPROVING HAND HYGIENE COMPLIANCE
Author(s): Stephanie Williams (; Akron Children’s Hospital)
Sharon Maley (); Akron Children’s Hospital)
Problem Statement: Akron Children’s Hospital (ACH) has been involved in various hospital initiatives to increase hand hygiene compliance rates as a method for decreasing the rate of hospital acquired infections. Even with focused efforts from various departments, ACH has rarely met the organizational goal of 85% hand hygiene compliance.
Project Description: A pilot project to improve the hand hygiene compliance rate was performed on one of the inpatient general care units at Akron Children’s Hospital. The unit had a baseline hand hygiene compliance rate of 42% in July 2013.
Lean Six Sigma methodology was used to 1) define the problem, 2) measure the compliance rate, 3) analyze the problem, 4) improve upon the vital issues, and 5) control the improved results.
In analyzing the vital issues, it was determined that knowledge and remembrance were the key issues that if solved, would create the largest improvements. Because this would involve behavior change, the Influencer Model (Influencer: The New Science of Leading Change by J. Grenny, et al.) was used.
The Influencer Model states there are 6 different sources of influence that impact successful change; when at least 4 of those sources are used, success improves 10-fold. In order to change hand hygiene behavior we 1) made the undesirable desirable by invoking personal motivations, 2) surpassed our limits by establishing personal ability, 3) harnessed peer pressure by employing social motivation, 4) designed rewards and demanded accountability with structural motivation, and 5) enabled the environment through structural ability (J. Grenny, et al, 2013).
Results: The pilot project achieved a compliance rate of 87.6% by December 31st, 2013, exceeding the project goal and the Organizational goal of 85%. Nursing staff made the most improvement (from 44.05% to 90%) and zero Hospital Acquired Infections (SSI, CLABSI, CAUTI, or VAP) were found on the unit during the project.
Conclusions: Several takeaways from the project include a multidisciplinary team is a must when trying to impact a far-reaching technique like hand hygiene. All staff needs to be involved and heard in order to make sustainable change. Additionally, the Influencer Model taught us that making only one or two changes will likely result in unsustainable success; leveraging the 6 sources of influence led the improvement process and the success of the project. Finally, accountability is key! The project leader was not from the unit, but by partnering with the nurse manager and by posting daily hand hygiene compliance rates, everyone became accountable for the hand hygiene performed on the unit. The success of this pilot project has started a hospital wide initiative to improve hand hygiene in all patient care areas. Phase 1 of the four phase initiative is well underway, with similar results being seen and phase 2 started in April.