Clean SavesA Patient Safety Program for Washington Hospitals

Joyce Winter, RN

Clean SavesBest practices for elevating hand hygiene compliance above 90% for longer than 12 month periods

Hand Hygiene

Compliance

Health Care Associated Infections

Worried?

Hand Hygiene Compliance fades

with time

Causing trouble…

Health Care

Associated Infections

Patients

Healthcare System

Hospital Personnel

Taxpayers

What to do?

Evidence Based

Practice

↑ Hand Hygiene

Compliance

↓ Health Care Associated Infections

Join in!

Illinois Masonic Medical Center

The Heart Hospital Baylor Plano

Vanderbilt University Medical Center

Memorial Sloan-Kettering Cancer Center

St. Christopher's Hospital for Children

Cincinnati Children’s Hospital

Culture Change

Baseline Data

Motivational Interviews

Inter-disciplinary

Champions Education

External Connections

Observations

Feedback

↑ HHC

↓ Fewer HCAIs

↑Lives & Money Saved

Culture Change

Gain Commitment

Model Behaviors

Modify Behavior

Improve Skills

Compelling Story

Role Modeling

Capability Building

Reinforcing

Culture Change

Gain Commitment

Model Behaviors

Modify Behavior

Improve Skills

Keller, S., & Aiken, C. (2009). The inconvenient truth about change management. McKinsey Quarterly.

Cornerstone #1 Keller, S., & Aiken, C. (2009). The inconvenient truth about change management. McKinsey Quarterly.

Spin a Compelling Story

Motivational interviewing + / - Behavioral

motivators

Gain Commitment

Cornerstone #2 Keller, S., & Aiken, C. (2009). The inconvenient truth about change management. McKinsey Quarterly.

• Compliance not Commitment

• False Reflections

“Yes, sir.”

Model the Behavior

Model Behaviors

Reinforce Change

↑Surprise ↓Money

Cornerstone #3 Keller, S., & Aiken, C. (2009). The inconvenient truth about change management. McKinsey Quarterly.

Modify Behaviors

Cornerstone #4 Keller, S., & Aiken, C. (2009). The inconvenient truth about change management. McKinsey Quarterly.

Mindsets – build BELIEF

Field & Forum – overcome BARRIERS

Capability Building

Build Skills

Changing culture Greenhalgh, T., Rober, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review. The Milbank Quarterly, 82(4), 581-629. Retrieved May 2013.

Culture Change

Baseline Data

Motivational Interviews

Inter-disciplinary

Champions Education

External Connections

Observations

Feedback

↑ HHC

↓ Fewer HCAIs

↑Lives & Money Saved

WHO’s Hand Hygiene Self Assessment Framework

Baseline Hand Hygiene Compliance Rates

Baseline Data

Modify Behavior

Gain Commitment

Mot

ivat

iona

l Int

ervi

ews

createsystem tension, a compelling story, complexity, innovation-system fit, negotiation amongst adopters, and

perceived relative advantage

anticipate implications (i.e. task issues)

build capabilities and confidence

Interdisciplinary Engagement

• Vertical integration• Hand Hygiene Council• Covert observers

Gain Commitment

Ch

amp

ion

s • Opinion leaders• Multidisciplinary• Model hand hygiene

AND receiving feedback

Gain Commitment

Interactive

Field and forum

Education

Improve Skills

Personnel 5 Moments

Less than you think

Peer feedback

Less recontamination

Fewer gloves

Patients Why it’s important

How to get clean

Asking health care workers

Education (cont.)

Improve Skills

External Connections

•Local school contests•Media interaction

Gain Commitment

Modify Behavior

• Varies with unit performance levels

Overt

• Gold Standard

Covert

Observations

Hand Held Device Data Collection

• iScrub•Germ Patrol

Modify Behavior

Behavioral FeedbackC

ompl

ianc

e • Timely• Individualized• Competitive• Customizable

Con

tinu

al • Screensaver• Posters

Cor

rect

ing • Professional

peer feedback• Violation

letters

Modify Behavior

Remember

If they can do it, we can too.

Harness change theory.

It’s a team effort.