Comments on: 100% is the Only Goal http://www.leanblog.org/2007/04/100-is-only-goal/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Thu, 09 Feb 2012 02:40:19 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Management’s Job is to be Proactive — Lean Blog http://www.leanblog.org/2007/04/100-is-only-goal/#comment-22835 Management’s Job is to be Proactive — Lean Blog Thu, 28 Jul 2011 03:32:32 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-22835 [...] beat up on MGH for a problem that plagues most hospitals (poor handwashing, something I’ve written about before and something David Mann commented on)? Ok, sorry, that was sarcasm. What does the Joint Commission [...] [...] beat up on MGH for a problem that plagues most hospitals (poor handwashing, something I’ve written about before and something David Mann commented on)? Ok, sorry, that was sarcasm. What does the Joint Commission [...]

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]]> By: Anonymous http://www.leanblog.org/2007/04/100-is-only-goal/#comment-2097 Anonymous Wed, 30 May 2007 21:02:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-2097 Healthcare leaders should open meetings with a hand washing excersize or demonstration. When people see the boss washing his hands, they'll be more likely to do it too. Healthcare leaders should open meetings with a hand washing excersize or demonstration. When people see the boss washing his hands, they’ll be more likely to do it too.

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]]> By: Chadwick http://www.leanblog.org/2007/04/100-is-only-goal/#comment-1894 Chadwick Mon, 09 Apr 2007 15:45:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-1894 I work for a pediatric teaching hospital who wrestles with this very issue.<br/><br/>We've made some gains over the years, but it really is vexing that we can't achieve 100% compliance. We've approached this problem from several angles: every patient room has a wall mounted purell dispenser, we have reminder stickers in every bathroom (and many other places), and we address this topic frequently in our internal communications.<br/><br/>I'll bet that the secret surveyors weren't expected to intervene when they observed a non-washing incident. While that would have been ideal, especially considering that patients lives are at stake, thre is commonly a large cultural divide between physicians and hospital staff, and most staff wouldn't feel comfortable intervening. I'm not saying that's ideal, but it's the probable reality.<br/><br/>Unfortunately, there is often a delicate genius mentality among physicians: their time and attention is thought too precious to focus on mundane hospital initiatives. We've spent years working to shift this mindset, and we're making progress. I work for a pediatric teaching hospital who wrestles with this very issue.

We’ve made some gains over the years, but it really is vexing that we can’t achieve 100% compliance. We’ve approached this problem from several angles: every patient room has a wall mounted purell dispenser, we have reminder stickers in every bathroom (and many other places), and we address this topic frequently in our internal communications.

I’ll bet that the secret surveyors weren’t expected to intervene when they observed a non-washing incident. While that would have been ideal, especially considering that patients lives are at stake, thre is commonly a large cultural divide between physicians and hospital staff, and most staff wouldn’t feel comfortable intervening. I’m not saying that’s ideal, but it’s the probable reality.

Unfortunately, there is often a delicate genius mentality among physicians: their time and attention is thought too precious to focus on mundane hospital initiatives. We’ve spent years working to shift this mindset, and we’re making progress.

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]]> By: Mark Graban http://www.leanblog.org/2007/04/100-is-only-goal/#comment-1867 Mark Graban Thu, 05 Apr 2007 23:30:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-1867 I appreciate the comments, plus another real helpful email I received (checking to see if I can share).<br/><br/>I think:<br/><br/>1) Not starting by yelling and threatening punishment is the right start. <br/><br/>2) Having a "tip line" to report the bad practice and tracking the # of reports (without punishing violators) would be a good start<br/><br/>3) Education and constant reminders must be key<br/><br/>The thing I have trouble getting my head around... do we really have to educate MD's that washing hands is good?<br/><br/>Hate to be cynical, but maybe insurers and payers should make "hand washing" a chargeable task. <br/><br/>When a factory talks about "True North" and not cutting corners in quality or safety in the name of getting the production numbers, shouldn't we expect the same of MD's? <br/><br/>"Not having time" rings really hollow and it would piss me off to hear it from a doc.<br/><br/>I'm trying to exercise my "respect for people" chops, but if a caregiver isn't following proper hygiene (and this includes OR dress and behavior), my patience and respect runs thin.<br/><br/>What about respect for the patient? That should come first. I appreciate the comments, plus another real helpful email I received (checking to see if I can share).

I think:

1) Not starting by yelling and threatening punishment is the right start.

2) Having a “tip line” to report the bad practice and tracking the # of reports (without punishing violators) would be a good start

3) Education and constant reminders must be key

The thing I have trouble getting my head around… do we really have to educate MD’s that washing hands is good?

Hate to be cynical, but maybe insurers and payers should make “hand washing” a chargeable task.

When a factory talks about “True North” and not cutting corners in quality or safety in the name of getting the production numbers, shouldn’t we expect the same of MD’s?

“Not having time” rings really hollow and it would piss me off to hear it from a doc.

I’m trying to exercise my “respect for people” chops, but if a caregiver isn’t following proper hygiene (and this includes OR dress and behavior), my patience and respect runs thin.

What about respect for the patient? That should come first.

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]]> By: Anonymous http://www.leanblog.org/2007/04/100-is-only-goal/#comment-1866 Anonymous Thu, 05 Apr 2007 22:13:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-1866 Read the TWI article below, and try TWI. <br/><br/>We can not assume that everyone knows and understands the rules unless they have been properly trained. Yelling at employees and putting posters in the hallway is not training.<br/><br/>Good training starts with a clear standard, and requires one-on-one instruction until you know the person understands.<br/><br/>If the person hasn't learned, the instructor hasn't taught! Read the TWI article below, and try TWI.

We can not assume that everyone knows and understands the rules unless they have been properly trained. Yelling at employees and putting posters in the hallway is not training.

Good training starts with a clear standard, and requires one-on-one instruction until you know the person understands.

If the person hasn’t learned, the instructor hasn’t taught!

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]]> By: Dean Bliss http://www.leanblog.org/2007/04/100-is-only-goal/#comment-1865 Dean Bliss Thu, 05 Apr 2007 19:32:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-1865 Infection control is a vexing issue, for many of the reasons Mark stated in his blog. We're addressing it by frequent reminders, placing hand-washing stations and/or gel stations (gel is actually better than washing with soap and water) in more convenient places, and raising awareness of the ways infections are spread. One of the biggest reasons for not washing that we've heard is time - being in a hurry to get to the next patient or the next case. It's a tough issue, but it's one that's essential, and we're using our Lean knowledge to help. Infection control is a vexing issue, for many of the reasons Mark stated in his blog. We’re addressing it by frequent reminders, placing hand-washing stations and/or gel stations (gel is actually better than washing with soap and water) in more convenient places, and raising awareness of the ways infections are spread. One of the biggest reasons for not washing that we’ve heard is time – being in a hurry to get to the next patient or the next case. It’s a tough issue, but it’s one that’s essential, and we’re using our Lean knowledge to help.

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]]> By: Matt http://www.leanblog.org/2007/04/100-is-only-goal/#comment-1864 Matt Thu, 05 Apr 2007 18:15:00 +0000 http://leanblog.bigbigdesign.net/2007/04/100-is-the-only-goal/#comment-1864 Secret observers?! Sounds like inspection waste of the worst kind.<br/><br/>I'm certainly no expert in this, but it seems that hospitals might consider asking "Why" a few more times, to get to some better root causes. The 3 reasons you state are a good start, but given the magnitude and potential impact of the problem, there must be some other more basic reasons. Since hygiene is normally a personal habit, it would seem that the reasons for non-compliance would be largely personal as well, and getting to the root of that will require careful questioning and respect.<br/><br/>My wife, who works in medicine, can add one more reason: washing her hands all of the time dries them out and causes the skin to crack, which is painful (it also increases the places for bacteria to flourish). Maybe hospitals should dispense with hand washing and insist on frequent glove changes? Secret observers?! Sounds like inspection waste of the worst kind.

I’m certainly no expert in this, but it seems that hospitals might consider asking “Why” a few more times, to get to some better root causes. The 3 reasons you state are a good start, but given the magnitude and potential impact of the problem, there must be some other more basic reasons. Since hygiene is normally a personal habit, it would seem that the reasons for non-compliance would be largely personal as well, and getting to the root of that will require careful questioning and respect.

My wife, who works in medicine, can add one more reason: washing her hands all of the time dries them out and causes the skin to crack, which is painful (it also increases the places for bacteria to flourish). Maybe hospitals should dispense with hand washing and insist on frequent glove changes?

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