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New Joint Commission Project Tackles Handwashing Missteps


The Joint Commission recently launched the Center for Transforming Healthcare, an entity that involves teaming with hospitals and health systems nationwide to measure and practice methods that aim to stop breakdowns in patient care, such as wrong-site surgery and improper communication. The first stop? Handwashing.

The answers to unacceptable and infrequent handwashing seem simple and yet have proved illusive at many institutions. To gain more accurate data and to explore the efficacy of potential solutions to the handwashing problem, the Center for Transforming Healthcare sent task members to eight volunteer hospitals and health systems. The project started in December of 2008. The participating centers include: Cedars-Sinai Health System, Los Angeles; Exempla Lutheran Medical Center, Wheat Ridge, Colo.; Froedtert Hospital, Milwaukee, Wis.; Johns Hopkins Hospital and Health System, Baltimore; Memorial Hermann Health Care System, Houston; Trinity Health, Novi, Mich.; Virtua, Marlton, N.J.; and Wake Forest University Baptist Medical Center, Winston-Salem, N.C.

“Demanding that healthcare workers try harder is not the answer,” said Mark Chassin, MD, MPP, MPH, president of the Joint Commission, in a news release.”These healthcare organizations have the courage to step forward to tackle the problem of handwashing by digging deep to find out where the breakdowns take place so we can create targeted solutions that will work now and keep working in the future. A comprehensive approach is the only solution to preventing bad patient outcomes.”

The Joint Commission’s Robust Process Improvement (RPI)™ toolkit includes a variety of methodologies—Lean Six Sigma and change management principles and methodologies, says Anne Marie Benedicto, MPH, MPP, vice president of operations for the Joint Commission Center for Transforming Healthcare.

“The idea is to use a proven systematic approach to analyze specific breakdowns in care, discover the underlying causes, and develop targeted solutions that solve complex problems while building support and acceptance among staff and leadership that are critical to sustaining the solutions created,” Benedicto continues. “That’s what RPI is all about.”

The Joint Commission claims that the following factors are the main root of anemic handwashing practices:

•Ineffective placement of dispensers or sinks

•Hand hygiene compliance data are not collected or reported accurately or frequently

•Lack of accountability and just-in-time coaching

•Safety culture does not stress hand hygiene at all levels

•Ineffective or insufficient education

•Hands full

•Wearing gloves interferes with process

•Perception that hand hygiene is not needed if wearing gloves

•Healthcare workers forget


While the Joint Commission supports the use of efficacious process-improvement methodologies, it doesn’t require a specific methodology. The solutions are meant to be simple and customizable.

“The goal of translating the Center’s work is to make the solutions free of jargon and easy-to-use by clinicians and quality professionals al-ready on staff at healthcare organizations,” Benedicto says. “This means hospitals don’t have to adopt Lean Six Sigma, hire Black Belts or retain consultants in order to implement the solutions identified by the Center.”

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