Revisiting Handwashing, Time, Systems, and Blame
I've struck a chord with a few nurses with this post from late last year:
I've written before about my questions of why so many hospitals abdicate their leadership responsibility for quality and patient safety, or at least offload much of it onto the patients. I think it's wrong to put patients of the position of asking the providers if they've washed their hands. The hospital, the providers, the physician leaders, and the administrators need to take on this challenge. They need to fix processes and put better management systems in place. That's getting closer to fixing the real root cause of these problems instead of asking families to play the role of “quality inspector.”
I'd invite you to visit the post and the comments (including my responses). I'm not blaming the nurses as individuals. If proper hand hygiene does not occur, it's not their fault, it's a system problem.
I think some key questions to ask are:
- If it's “inexcusable” (in the 2nd nurse's words) for errors to occur, why is “we don't have time” an acceptable excuse for not washing your hands enough?
- If we don't have time, is that end of story or can we do things to improve the process to free up time and take away the excuse?
- If management has assigned 8 to 10 patients to a nurse and there's “not enough time” to do things the right way, who notices? Do we have data that shows that an RN can really take care of 8 to 10 patients the right way or was that driven by budgets and leaders who don't know the reality of the work? A 6:1 ratio would cost more in the short-term, but what are the long-term costs in terms of infections and patient care/safety?