Thursday, June 11, 2009

Hand Washing in Hospitals (Part 2)

I'm sitting here at the St Louis Bread Shop (Panera Bread to you folks not in St. Louis) wondering if the lady who grabbed my cinnamon roll with her bare hands followed proper hand washing guidelines...which brings me back to our case study...

So, have you figured out how you would save lives by improving hand washing compliance at your hospital? This is not only a change leadership challenge, but in this circumstance a case of life and death. The hospital in our case study hit this issue head on. When a new CEO took over the leadership of the regional health care network that included this hospital, he made the problem of hospital infections his top priority. To prove he could solve this problem, he hired a young industrial engineer named Peter Perreiah to focus on a single forty bed floor at the hospital. Peter adjusted his pocket protector and walked right onto the floor and asked all of the staff "Why don't you wash your hands?" Far and away the most common answer was a lack of time. So Peter set out to eliminate the things that wasted precious time.

He developed a just in time supply system positioned right inside patient rooms to prevent the staff from having to go in and out in search of gowns, gloves, tape, and other items. Rather than carrying their own stethoscopes and risk spreading infection from patient to patient, he positioned a designated stethoscope in each room. He made dozens of other changes to reduce waste in providing patient care, all with the intention of freeing the time needed for proper hand hygiene. Finally, like a good engineer, Peter arranged for every patient to have a nasal culture taken upon admission so he could carefully measure infection rates that originated in the hospital itself.

The result? MRSA infection rates fell almost 90 percent, from four to six infections a month to about that many in an entire year! But before you engineers and lean experts high five each other, here's the bad news. After two years only one other floor in the hospital had adopted similar changes, and when Peter left the hospital performance quickly backslid to baseline rates. The CEO ended up quitting out of frustration over the lack of progress. Nothing had fundamentally changed.

So, give this some thought. Why did changes that made care givers' lives easier and more productive, changes that produced significant and verifiable results, fail to spread or be sustained? Why did the inertia turn back to prior practices in the face of overwhelming evidence of success? Why do people fight change even when they know lives are on the line? Why do they fight change in your organization?

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