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December 8, 2016

This hospital stopped non-essential care for 30 minutes—and improved hand hygiene for 6 years

Daily Briefing

Editor's note: This popular story from the Daily Briefing's archives was republished on July 8, 2019.

Nationwide Children's Hospital (NCH) needed to improve its hand-hygiene compliance—so it took inspiration from the military, Elizabeth Whitman writes for Modern Healthcare.

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NCH clinicians reported in internal surveys several years ago that they already had excellent hand-hygiene compliance, but subsequent secret audits revealed that compliance was actually less than 60 percent. That isn't unusual, considering that CDC estimates that health care workers on average wash their hands less than half as frequently as they should.

Nevertheless, Terrance Davis, assistant to the hospital's CMO, said the audits were a wake-up call. "We were looking for some way of dramatically getting hand hygiene high on everyone's agenda," he explained.

Getting creative

One strategy NCH settled on was to conduct a so-called "stand down," which is a practice associated with the military. The idea involves halting all non-essential activities to focus on something of high importance. For instance, after a series of helicopter crashes in 2015, the Army directed nearly all of its aviation units to stand down for five days' worth of safety checks and training.

During two 15-minute drills during a single day in spring 2010, NCH took the same approach—but focused on hand hygiene. "Everyone and everything except essential patient care ground to a halt," Whitman writes. During the stand down, each unit's staff, physicians, and nurses were briefed on a hand-hygiene action plan by a manager.

A key message delivered during the briefings, according to Davis, was that failing to follow hand-hygiene protocols would have consequences. If units or individuals didn't achieve 90 percent compliance or were observed not following best practices, "they would have to meet with the CMO or CNO, or their designates, to explain why," Whitman reports.

Laying the groundwork

But NCH's leadership didn't want to punish members of the care team; they wanted to set them up for success. Before managers outlined their action plans, the hospital installed new hand sanitizer dispensers outside of every patient room and at key junctures, such as elevators. "We had to make it really, really easy to find that gel," Davis said.

And hospital leaders went out of their way to seek buy-in from medical and nursing directors by convening a summit to brief them on the plan and by giving them time to design unit-specific action plans.

Dramatic results

"Within a month of the stand-down, compliance rates hit 90 percent, and they've stayed that way for six years," Whitman reports. Over the same period, Davis said, the rate of health care-acquired infections—such as central line infections—has dropped significantly.

Davis credits NCH's multipronged approach with enabling the turnaround: The stand down drove home the seriousness of the issue, leaders engaged with the effort, and people were held accountable.

But Davis also quipped that the accountability piece may have played a larger role than the others. "It turns out it's pretty embarrassing to be called to the principal's office to explain why you're not doing your job," he said (Whitman, Modern Healthcare, 12/3; Tan, Army Times, 12/3/15). 

Help patients take an active role in their care

Even the best care won't result in strong outcomes unless patients are ready and willing to follow care recommendations, make necessary lifestyle changes, and play an active role in managing their own care.

That's why it's crucial that frontline clinicians have the skills to tap into patients' motivation to change. Our toolkit gives managers the resources they need to help clinicians do just that.

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