Joint Commission Resources today released the January 2015 issue of the Joint Commission Journal on Quality and Patient Safety. The issue includes two articles and an accompanying editorial on hand hygiene compliance, which reduces rates of healthcare-associated infections in hospitals but has proven difficult to improve on a sustained basis.
In the first article, “Improving Hand Hygiene at Eight Hospitals in the United States by Targeting Specific Causes of Noncompliance,” Mark R. Chassin, MD, FACP, MPP, MPH, president and chief executive officer of the Joint Commission, and co-authors provide a detailed account of the Joint Commission Center for Transforming Healthcare’s first patient safety project on hand hygiene. The Center convened teams of experts in performance improvement and infectious diseases from eight hospitals for the project, which was conducted from December 2008 to September 2010. Lean, Six Sigma and change management methods were used to measure the magnitude of hand hygiene noncompliance, assess specific causes of hand hygiene failures, develop and test interventions targeted to the specific causes, and sustain improved levels of performance.
Hand hygiene compliance averaged 47.5 percent across all eight hospitals, and initial data revealed 41 different causes of hand hygiene noncompliance. Key causes varied greatly among the hospitals. To address the high rate of noncompliance, each hospital developed and implemented specific interventions targeted to its most important causes of hand hygiene noncompliance. The improvements were associated with a 70.5 percent increase in compliance across the eight hospitals —to 81 percent, a level of performance that was sustained for 11 months through the end of the project period.
Following the project, the Center worked with an additional 19 hospitals to create Web-based tools to enable health care organizations to use the same methods employed by the original eight hospitals without needing any knowledge or experience with Lean, Six Sigma or change management. In the second article, “Beyond the Collaborative: Spreading Effective Improvement in Hand Hygiene Compliance,” Chassin and colleagues chart the development of the Center’s Targeted Solutions Tool® (TST®) for hand hygiene. The tool helps organizations discover the most important, specific causes of hand hygiene noncompliance in their facilities and target interventions at those causes.
In the first three years, 289 healthcare organizations used the TST® to initiate 1,495 projects to improve hand hygiene compliance. Of the 769 projects at 174 organizations for which baseline and improvement data were available, average compliance improved from 57.9 percent to 83.5 percent. Similar improvement was observed in many clinical care settings, including ambulatory, long term care, inpatient pediatrics, critical care and adult medical/surgical units.
In an accompanying editorial, “Toward More Reliable Processes in Health Care,” Peter Pronovost, MD, PhD, of Johns Hopkins Medicine in Baltimore, supports the implementation of using Lean, Six Sigma and change management methods in healthcare. Pronovost emphasizes the importance of managers and leaders championing quality improvement processes as a way to manage and lead their healthcare organizations. The editorial concludes, “In the struggle to find the balance between art and science, patients would be better served if more emphasis was placed on management science.”
Source: Joint Commission Resources (JCR)