Infections acquired in the hospital are currently one of the major causes of mortality and morbidity. Proper hand hygiene practices, in turn, are considered to be an effective way to prevent the transmission of infections during communication and interaction between patients and medical staff. Despite the fact that health professionals are aware of the importance of hand hygiene, compliance levels remain low in many facilities, including the organization in question. Since Novant Health is one of the facilities where patients’ length of stay is on average longer, ensuring proper hand hygiene compliance is essential to reduce hospital-acquired infections and other negative consequences (Novant Health, n.d.). Investing in the new technology aimed at improving hand hygiene compliance will therefore allow the board to prevent numerous health consequences that are dangerous both for patients and clinicians working in the given facility. In turn, lack of sufficient investment in this technology may cause health workers’ negligence and poor motivation to practice hang hygiene, which will lead to the transmission of germs, including antibiotic-resistant microorganisms. Thus, new process changes need to be introduced to ensure higher levels of hand hygiene compliance.
The Impact of the Change
Specific recommendations suggested as a part of this proposal will include the introduction of the Hand Hygiene Compliance Application, which will help health professionals to monitor and improve their hand hygiene compliance. The design and the functionality of the app will be developed in a way that will ensure that users are provided with the most convenient way to report and monitor their compliance rates. In addition, health professionals will need to be consulted on the importance of using the app and how it will affect the overall performance rates of their facility. These specific recommendations should currently be a priority because they will allow to direct the board’s attention towards those areas of the facility’s operations that need to be targeted. Most importantly, this change will ensure that the organization acts according to its mission “to improve the health of communities, one person at a time” (Novant Health, n.d., par. 2). Since the main concern associated with poor hand hygiene compliance is patients’ health and well-being, following the recommendations presented will have a significant positive impact on the organization’s ability to meet its mission.
In addition, the organization will be able to have return on investment as a result of introducing and investing in this change. This is mainly due to the fact that improved hand hygiene compliance will reduce the prevalence of hospital-associated infections, and the number of patients that have to be treated from them will decrease. Consequently, the organization will also be able to have greater efficiency and lower operational costs. Another important advantage for Novant Health as a non-for-profit organization is the opportunity to do social or public good.
Planning a Process Change
To plan for a process change aimed at improving hand hygiene (HH) compliance, the task force would use the PDSA model, data collection, process mapping, and process analysis tools, such as flowcharts and diagrams. The PDSA model will allow creating a step-by-step plan for the improvements by implementing a “trial-and-learning” method and evaluating changes in a time-efficient manner (Gould et al., 2017). Data collection tools that will be used include a standard HH observation form, WHO’s Data Collection Tool, and a researcher-made HH questionnaire (Alper, 2021). This data will then be statistically analyzed using process analysis tools and techniques, such as Paired-samples T-test and Chi-squared test (Gould et al., 2017). Process mapping will be used to create a detailed visualization of the process change, depicting all the individuals and parties involved in implementing and maintaining this change. The combination of these models, techniques and tools will allow documenting the process, as well as to model, analyze, and manage workflows to ensure the highest level of compliance.
Measuring Compliance
Compliance to hand hygiene practices introduced will be measured through a direct observation program which will intersect with the “study” phase of the PDSA model. Observers for the program will be trained “on the WHO’s 5 Moments for Hand Hygiene poster and WHO’s Hand Hygiene Training Films” (Alper, 2021, par. 4). Inner-rate reliability will also have to be assessed to ensure that observers provide consistent data. WHO’s Data Collection Tool, researcher-made HH questionnaires, and a standard HH observation form will be used to conduct direct observations, after which the data will be compiled into a single database. Reports and graphs demonstrating the performance will then be created using the master database. Finally, the front-line staff will be provided with feedback, and action plans will be created for all units and departments.
Causes and Effects of Noncompliance
There is a number of reasons health professionals do not comply with hand hygiene requirements. Studies conducted in hospitals across the country have shown that healthcare workers often forget to wash their hands because they get distracted or have to enter or exit the room quickly (Clancy et al., 2021). Many professionals also feel that wearing gloves eliminates the need to wash their hands. Ineffective and insufficient education concerning safety norms in a healthcare facility is also among the most common causes of noncompliance, as are broken or inconveniently placed sinks and dispensers. Other factors contributing to the issue are skin irritation some workers have from the cleaning products and the lack of alternative products (Sands & Aunger, 2020). In addition, some workers have reported that their hands were often full with supplies, and that there was no convenient place to put them in order to wash their hands.
Even if the noncompliance issue is isolated to only a few staff, it poses certain risks for the improvement process. If some healthcare workers demonstrate poor hand hygiene compliance, patients’ safety will remain jeopardized due to the spread of hospital-acquired infections, posing threats to all people admitted and discharged from the hospital. Moreover, non-compliance practices are likely to become more widespread, compromising the safety of other workers and patients.
Additional Recourses
To develop a hand-hygiene procedure, the taskforce may need additional resources and information. First, the researchers and observers will have to study the strategies and interventions recommended by the World Health Organizations concerning hand hygiene compliance (Alper, 2021). Electronic Message Boards will also be required to provide workers with the means to receive daily reminders, updates, and other information (Sands & Aunger, 2020). In addition, different types of signage, such as flyers and posters will have to be posted in various places, such as bathrooms, nurses’ rooms, hand sanitizing stations, etc.
Ensuring Compliance
Compliance can be ensured through regular discussions held for the workers to gain their feedback and self-reflections regarding the implementation of the change. Health professionals will be asked to share their experiences and thoughts, assessing their own compliance with hand hygiene requirements. The observers will also be asked to share their conclusions, and different viewpoints can be compared in order to gain a broader understanding of the issue. This will also allow the taskforce to analyze the change implementation and introduce necessary modifications at any given stage of the process (Sands & Aunger, 2020). In addition, the taskforce can install more hand-washing stations and sanitizers, as well as tables and other surfaces for supplies, which will make it easier for workers to wash hands more often.
Conclusion
The planning and implementation processes described above allow the conclusion that this change would be highly beneficial for Novant Health, as it will focus on one of the organization’s main problems. It can be argued that the initiatives presented align with the organization’s strengths, such as focus on patient care and financial stability. These factors will provide the organization with opportunities and resources to successfully introduce the change. Despite the organization’s strengths, relatively low hang hygiene compliance rates are still its major weakness, which will, however, directly be influenced by this initiative. To ensure successful implementation of the change, staff will have to undergo a short training program aimed to develop skills for the successful use of the new technology. No additional competencies will be needed within the staff of Novant Health. New organizational capability that might be required to use this technology effectively is a team of qualified specialists in computer programming and design engineering to develop and maintain different aspects of the technology introduced.
References
Alper, P. (2021). Best practices for measuring hand hygiene compliance. Medline. Web.
Clancy, C., Delungahawatta, T., & Dunne, C. (2021). Hand-hygiene-related clinical trials reported between 2014 and 2020: A comprehensive systematic review. Journal of Hospital Infection, 111, 6-26. Web.
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews, 17(9). Web.
Novant Health. (n.d.). The mission that drives us and the values that guide us. Web.
Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. PLOS ONE, 15(4), e0230573. Web.