Thoughts on Handwashing from David Mann
Some good discussion was raised on my original post, thinking out loud about what lean management methods you should use to get clinical healthcare providers to wash their hands 100% of the time, in the name of patient safety.
Here are some thoughts from an email exchange with David Mann, author of the excellent book Creating A Lean Culture: Tools To Sustain Lean Conversions (used with his express permission). I was curious about his general model for solving the “how do I get compliance?” problem.
Some thoughts based on a simple model of learning: knowledge, practice, feedback:
1. Are there visuals at the point of use (where handwashing occurs) based on, for example, time sample observations, that show percentage compliance versus the 100% goal? This feedback would be the equivalent of posting lean assessment scores or 6-S audit results.
1a. Is there something like a 6-S audit in which this practice is simply one of those explicitly expected and audited? If not, seems like it might be good to start.
2. Is there a method for reporting failures to comply. These could be anonymous (initially); the object is to provide feedback on daily or weekly (for example) performance which virtually all in the health care setting would agree (I’m assuming) is important.
3. Is knowledge of the situation widely disseminated? Are findings from consequences made visible, in incidence percentage (PPM?) and counts based on root cause analysis of the subject infections, plus those resulting in death? Are the data widely visible? Visuals raise the level of accountability and disseminate responsibility. Are there only a few with the data doing all the worrying? It wouldn’t be unusual if that were the case.
4. Is there the equivalent of a stand up meeting at some frequency where this subject and results (as from 1- 3, above) could be touched on? Counting on good habits to persist without reinforcement, measurement, and reminders isn’t a robust strategy. As you’ve said, hope isn’t a plan – unless you’re the chaplain!
5. Following a month or a quarter of implementing some or all of the above steps, consider converting step 2 from anonymous as to reporter and reported to the mode where the reported are identified by name and followed up by whatever authority with disciplinary action with the appropriate progressive steps. Or, begin random observation schedules by those in a position to initiate disciplinary action (progressively, of course) based on what they see.
In lean implementations, noncompliant individuals present themselves to be made examples of, part of their testing the system. The same will happen here, whether among staff or physicians. When it happens, it’s important to act. It’s often the case that the miscreant lets others know what happened: “You wouldn’t believe what they did to me!”, helping to spread the word. Organizations have discipline systems for good reason.