11

An organizational perspective An organizational perspective on hand hygiene: on hand hygiene:

a model for building to successa model for building to success

Carol VanDeusen Lukas, EdDCarol VanDeusen Lukas, EdDCenter for Organization, Leadership and Center for Organization, Leadership and

Management ResearchManagement ResearchDepartment of Veterans AffairsDepartment of Veterans Affairs

April 10, 2008April 10, 2008

22

BackgroundBackground Project in the Department of Veterans Project in the Department of Veterans

Affairs resulting from collaboration of: Affairs resulting from collaboration of: Directors and Chief Medical Officers of Directors and Chief Medical Officers of

three Veterans Integrated Health Care three Veterans Integrated Health Care Systems Systems

Center for Organization, Leadership and Center for Organization, Leadership and Management ResearchManagement Research

Lessons from Robert Wood Johnson Lessons from Robert Wood Johnson Pursuing Perfection (P2) shaped project Pursuing Perfection (P2) shaped project approachapproach

33

Project aimProject aim

To improve hand-hygiene compliance To improve hand-hygiene compliance using a three-pronged model to using a three-pronged model to strengthen the organization’s ability strengthen the organization’s ability to implement evidence-based clinical to implement evidence-based clinical practicespractices

44

Organizational model for Organizational model for improving evidence-based improving evidence-based clinical practicesclinical practices

Improved evidence-based clinical

practices

Active top leadership commitment

Links to senior management structures and

processes

Organizational infrastructure

Clinical process redesign

55

Clinical process redesign …Clinical process redesign … Actively engages middle & front-line Actively engages middle & front-line

staff around priority clinical issuestaff around priority clinical issue Works toward desired hand-hygiene Works toward desired hand-hygiene

performance through system redesign performance through system redesign to build new practices into daily workto build new practices into daily work

Builds skills, motivation and culture to Builds skills, motivation and culture to support and sustain quality support and sustain quality improvementimprovement Experience with systematic quality Experience with systematic quality

improvement and redesign teams improvement and redesign teams Confidence to tackle other problemsConfidence to tackle other problems

66

Redesign key actors, venues: Redesign key actors, venues:

Infection control professionals Infection control professionals Hand-hygiene championsHand-hygiene champions Multi-disciplinary redesign teamsMulti-disciplinary redesign teams

Collaborative, interdisciplinary work, including MDsCollaborative, interdisciplinary work, including MDs Systematic problem analysis, data collection, tests Systematic problem analysis, data collection, tests

of changeof change Shared learning groupsShared learning groups

77

Redesign activities: Redesign activities:

Education and awareness – what Education and awareness – what needs to be done needs to be done

Product selection and placement – Product selection and placement – make it easy to domake it easy to do

Social marketing – create imperative Social marketing – create imperative to changeto change

Monitoring and feedback – feedback Monitoring and feedback – feedback on how doingon how doing

88

Active top leadership Active top leadership commitmentcommitment...... Sets priorities for the organization Sets priorities for the organization

Establishes hand-hygiene as high Establishes hand-hygiene as high priority priority

Sets high expectations for performanceSets high expectations for performance Communicates commitment & goalsCommunicates commitment & goals Demonstrates personal commitment Demonstrates personal commitment

through use of own time through use of own time To quality in generalTo quality in general To hand hygiene in particularTo hand hygiene in particular

99

Leadership commitment Leadership commitment actions:actions: Set public goal for breakthrough Set public goal for breakthrough

performance in hand hygieneperformance in hand hygiene Model good hand-hygieneModel good hand-hygiene Talk with patients and staff about Talk with patients and staff about

hand hygiene on leadership rounds hand hygiene on leadership rounds Discuss hand-hygiene at employee Discuss hand-hygiene at employee

forumsforums Attend performance improvement or Attend performance improvement or

other quality committeesother quality committees

1010

Management structures & Management structures & processes…processes… Align redesign efforts with Align redesign efforts with

organization’s strategies and priorities organization’s strategies and priorities (top to bottom)(top to bottom) Actively support redesign with needed Actively support redesign with needed

resourcesresources Create accountability through measures, Create accountability through measures,

reporting and monitoring progressreporting and monitoring progress Integrate activities across Integrate activities across

organizational boundaries (facilities, organizational boundaries (facilities, workgroups, functions)workgroups, functions) Facilitate cooperation and problem Facilitate cooperation and problem

resolutionresolution Spread learning and reinforce cultureSpread learning and reinforce culture

1111

Management structure & Management structure & process actions:process actions: Identify cabinet champion or executive Identify cabinet champion or executive

sponsor to work with redesign effortssponsor to work with redesign efforts Monitor hand-hygiene performance at Monitor hand-hygiene performance at

leadership meetingsleadership meetings Hold low-performing areas accountable for Hold low-performing areas accountable for

improvementimprovement Leverage cooperation across professions Leverage cooperation across professions

and departmentsand departments Provide resources to recognize and Provide resources to recognize and

reward successreward success

1212

High-level performance builds High-level performance builds from all three elements: a VA from all three elements: a VA exampleexample High-performing academic medical High-performing academic medical

center with wide experience in center with wide experience in systematic quality improvementsystematic quality improvement

Well-established redesign team for Well-established redesign team for hand-hygiene with strong leadership hand-hygiene with strong leadership commitment and management commitment and management processes and supportprocesses and support

Hand-hygiene compliance ~80%Hand-hygiene compliance ~80%

1313

Urgency takes to a new level: Urgency takes to a new level: VA example continuedVA example continued Hand hygiene cited as problem in Hand hygiene cited as problem in

Joint Commission Survey Joint Commission Survey 30 days to reach 90%30 days to reach 90%

Blitz built on strong baseBlitz built on strong base Redesign team coordinated education, Redesign team coordinated education,

awareness, generation of new ideas from all awareness, generation of new ideas from all areasareas

Data collection increasedData collection increased Middle-managers held accountableMiddle-managers held accountable Chief of staff very active in holding physicians Chief of staff very active in holding physicians

accountableaccountable Reached, then exceeded 90%Reached, then exceeded 90%

1414

Sustaining improvementSustaining improvement

Aim to move from special project Aim to move from special project needing extensive attention to needing extensive attention to routine business, built into cultureroutine business, built into culture

But need periodic monitoring to But need periodic monitoring to sustain; hold accountable and take sustain; hold accountable and take action if performance drops offaction if performance drops off