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Sick of trying to improve hand hygiene without success? Try something different
Michael Gardam University of Toronto
hygiene without success? Try something different Michael Gardam - - PowerPoint PPT Presentation
hygiene without success? Try something different Michael Gardam - - PowerPoint PPT Presentation
Sick of trying to improve hand hygiene without success? Try something different Michael Gardam University of Toronto culture eats strategy for breakfast Education Senior Team Human Factors Support Improved hand hygiene compliance
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Improved hand hygiene compliance
Education
Audits Human Factors Patient Engagement Senior Team Support Opinion Leaders Behaviour modeling
JCYH, 2009
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Traditional Healthcare Culture
- Need to get things done immediately
- Evidence-based practice (scientific proof)
- Information and data are trusted
- Culture change is complicated
- Leaders need to ‘step-up’
- Top-down leadership from the senior team
Zimmerman et. al. Healthcare Papers 2013
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How we think the healthcare world works:
A B
How it really works:
W B
BLACK BOX
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In a Linear World
- One size can fit all
- Standardization works
- Copying best practices makes sense
- Top down leadership (“develop the
program and roll it out”) works
- Checklists work
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In a Complex World
- One size never fits all
- What works here may not work there
- “this is how we do things here”
- There is no “one big fix”
- Relationships matter
- Bottom up leadership works
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Minimum Specifications
(simple rules) rather than
Maximum Specifications
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Improving safety in a complex world Prevention Resilience
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RONT INE WNERSHIP
Zimmerman et. al. Healthcare Papers, 2013
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Buy in
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Ownership
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FLO uses:
- Positive Deviance
- Liberating Structures
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How to get here? From here?
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Rebuilding the wheel…
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Principles of This Work
- Participation is voluntary
- Bottom up, top down and sideways
- Make the invisible visible
- Include the unusual suspects
- Go slow to go fast
- Nothing about me without me
- Act your way into a new way of thinking
- Things may get worse before they get better
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How is this different from sharing best practices?
Front Line Ownership
- Winning practices are highly
sensitive to the local context
- Winning practices come
from those who are “touching the problem”
- Practices are spread virally
peer to peer
- Sustained
Sharing Best Practices
- What worked there should
work here. Variability is discouraged
- Winning practices come
from experts
- Practices are spread in top
down fashion
- Often not sustained
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This work is about the HOW rather than the WHAT
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The Hand Hygiene Hurdles
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10 20 30 40 50 60 70 80 90 100 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year % compliance
Our Success
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Cause & Effect Diagram
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Nursing engagement
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BOZ Outcomes to date
- 10% reduction in falls
- 11% reduction in pressure ulcers
- 44% increase in hand hygiene
- 100% decrease in catheter-associated urinary
tract infections
- 68% decrease in central line infections
- 11% reduction in surgical site infections
- Submitted for a “Best in Blue” award
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Culture SHIFT
- Taking time to think
- Practice-based evidence (social proof)
- Stories and relationships are trusted
- Culture change is simple
- Leaders need to step back
- Bottom up leadership from the front-line
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Summary
- Culture trumps everything else
- Nibble away at your problem
- Standardize what you must and then allow
variability
- Focus on the HOW not the WHAT
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“Insanity: doing the same things over and over again and expecting different results.”
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