Saturday, June 13, 2009

Hand Washing in Hospitals (Part 3)

As Paul Harvey always liked to say, "Now for the rest of the story..."

Not to be deterred from her mission, our infectious disease specialist Deborah Yokoe turned to a new product as a potential answer to the hand washing dilemma: alcohol rinses and gels. These items had actually been used in Europe for almost two decades, but had only recently caught on in the United States. These gels have the same potency as hand washing but can be applied and air dry in 15 seconds. Yet even this solution was met with resistance and took over a year to be adopted in the hospital. The staff feared the product would produce noxious odors. Next came fears that it would be irritating to the skin. Then rumors surfaced that the alcohol gel would reduce fertility. All of these rumors were false, but it took months to dispel each through communication and training. With the eventual adoption of the alcohol gels, compliance increased from 40 to over 70 percent. But surprisingly hospital infection rates didn't drop at all! Apparently the 30 percent non-compliance rate still allowed plenty of opportunity for the transmission of infections.

Not to be deterred by the failures of the industrial engineering efforts and alcohol gel adoption, surgeon Jon Lloyd continued to struggle with finding a way to reduce infection rates. Interestingly he received inspiration from reading an article about a Save the Children program to reduce malnutrition in Vietnam. After years of trying to bring outside solutions into Vietnamese villages only to be met with resistance, missionaries instead chose to find solutions from village insiders. They studied villagers who had the best nourished children and discovered that these mothers were breaking with locally accepted practices in many ways. They were feeding their children even when they had diarrhea, giving several small feedings a day, mixing greens in with their food, and other revolutionary practices. Aid workers shared these practices with other villagers and posted results for all the villagers to see. The ideas began to take hold and malnutrition dropped by 65-85% within two years in every village where this approach was taken.

Lloyd was struck by this idea and evaluated how it could be adopted by his hospital to reduce infection rates. With the help of the infectious disease specialists thirty minute small group sessions were held with health care workers at every level from food service workers to surgeons to nurses to janitors. They simply started the sessions by saying "We have a serious problem with the spread of infectious diseases in this hospital and we are here to learn your ideas on how to solve it." Many said it was the first time anyone had ever asked them what they would do about the problem, and ideas came pouring out. As a result of these sessions, norms began to change. When new gel dispensers were received staff members took charge of where to place them. Nurses began to confront doctors who were bypassing good hygiene practices. Therapists who didn't like to wear gloves during procedures were convinced by peers that it was no big deal. Ideas and small victories were publicized throughout the hospital and recognition given.

The result: One year into the effort MRSA wound infection rates dropped to zero. The Robert Wood Johnson Foundation recently launched a multi-million dollar initiative to adopt this approach in ten more hospitals across the country and study the results.

So what is there to learn for your organization in this case study? I would be interested to hear what you think, so please feel free to comment on lessons learned!


Anonymous said...

For those of you who receive IW magazine, there is a good article on an employee incentive program that is based upon continuous improvement.

-Chris Y.

Anonymous said...

This is a great study in process ownership. It wasn’t until the people within the process were given the chance to add valuable contributions to the project did it become sustainable – they became part owners of the goal to reduce infectious diseases. Great illustration! It goes to prove that there is “power” in “empowering” employees. I’ve learned this, unfortunately, the hard way. Kaizen events and projects that I have facilitated in the past have proven to be more sustainable when the folks involved in the event are able to contribute. Even when it appears that there is very little contribution from the group(s), just allowing for inputting and critiquing goes a very long way from the employee viewpoint (“do it with them, not to them”). It becomes more of a partnership when everyone can participate.

-Chris Y.

The Change Freak said...

Great link Chris! Thanks for sharing. I have already passed it on to some others that I thought would find it interesting.