100% is the Only Goal
To those who might have thought I overstated the situation with hand washing in hospitals, here's another article about maintaining proper hygiene among hospital staff and caregivers.
One particular risk is the bacteria Methicillin-resistant Staphylococcus aureus, or MRSA.
Susan Harp, M(ASCP), CIC, Columbus Regional infection control coordinator, says 40 to 60 percent of the population carries Staphylococcus in their nose.
“It lives there happily and many people can have staph and never have a day's problem,” she explained.
The problem is that many of us carry this around and we're OK, but when it's passed to someone who is susceptible, it can be deadly.
Karen Williams director of infection control at Hughston Orthopedic Hospital likens a hospital to a Petri dish with bugs moving around in a rich culture. That can cause bacteria and infections to spread.
The problem of drug-resistant bacteria is blamed on overuse of antibiotics…. a form of “overprocessing” in the Lean terminology (the “waste of overprocessing,” or doing more than is required to add value for the customer).
One “best practice” that helps stop the spread of MRSA — basic hygiene, such as washing hands with soap or using alcohol-based cleaning gels.
The problem is getting caregivers to wash their hands. As I highlighted in my earlier essay, the lack of hand washing is a real problem. Although caregivers report higher numbers, hospitals that do direct observation often find that the compliance rate can be under 50%. Washing hands saves lives, pure and simple. But hospitals often lament, “how do we get people to wash their hands?”
Well, how does a factory get employees to follow safety practices, such as wearing safety glasses?
- Leadership — set an example, a visible example?
- Explain Why — employees should be reminded that proper safety measures are not optional and are not secondary to quality or speed.
- Take Action — you need to observe to see if “standard work” is being followed. Hope is not a strategy. There have to be consequences for people not following the standard work safety practices.
Ideally, we, as leaders, need to treat people as adults, trust them to do the right thing. But, if that's not happening… you have to fall back on your formal power… the power to discipline employees. This happens in good factories every day…. if someone's not wearing their glasses, they're reminded and probably threatened with punishment or discipline, if need be. Here's a case where “lean leadership” isn't “nice” — you have to be tough when safety is involved. You can't just wait for someone to lose an eye before reacting and re-emphasizing safety glasses.
So why do hospitals find it so difficult to get compliance with hand washing standard work?
- Doctors are usually not employees. There is a different dynamic involved. Hospital administrators don't hold the same kind of authority over doctors that a plant manager might have over a supervisor or an assembly worker. Hospitals rely on doctors to bring patients (and therefore revenue), so it's common for administration to not hold MD's accountable for following a standard process (whether it's washing hands or filling out post-op paperwork in a timely manner).
- It's impossible to observe 100%. We can't possibly observe every MD every second of the day. I suppose the medical profession itself has to take this on, with colleagues pressuring or shaming their peers into handwashing compliance.
- Patients are often afraid to speak up. Many patient safety experts are urging patients to speak up, to keep giant Purell bottles by their bedside, and to insist that your caregivers wash/clean their hands in front of you. If your MD or RN is offended, that's probably a bad sign.
In the article, they talk about using “secret observers” to look for compliance:
“You have to be consistent and conscientious,” Harp said. She reports that at Columbus Regional they have secret surveyors, who watch for compliance.
“They look for opportunities when an employee should have washed, and then they see if they do,” she explained.
But what when they see these opportunities? Are they collecting data or driving improvement? Is anyone being punished for NOT washing properly?
I can't believe we're even spending time discussing something like this. You'd think basic hygiene would be “a given.”
One hospital mentioned in the article set a goal of “100%.” That's a good start. Safety goals need to be in absolute terms. Factory safety goals need to be “zero injuries.” Forget what people say is “impossible.” Setting a goal other than perfect sends a horrible message that it's “OK” for a certain number of injuries or deaths. At least the hospital execs aren't setting goals of “75% handwashing compliance.”
But setting the goal is just one part. Leadership and getting compliance to standard work is the ongoing challenge. Sad.
What advice would you give our healthcare leaders? Click “comments” to chime in.