Tina Schwien, MN, MPH
Quality Improvement Consultant
The Hand Hygiene Huddle is a practical, frontline driven approach to involving patients and families in your facility’s infection prevention efforts.
Stemming from a pilot program conducted under the CMMI Innovation Advisors program, the Huddle concept was further explored and developed through a CMS Special Innovation Project. Benefits of this approach may include improved patient satisfaction scores, increased hand hygiene rates, and improved patient and family confidence in speaking up to remind providers to perform hand hygiene.
The Roadmap, references and brief videos included below will help your team get started.
Focus on the Frontline Staff
Bruce Rehm, Lean Six Sigma Black Belt
Manager, Operational Improvement
Harrison Medical Center, Bremerton, WA
Solutions developed by the frontline are more likely to be implemented and become the new "normal." Encouraging your frontline teams to find solutions together has the added bonus of fostering communication, teamwork, camaraderie, and a learning culture. As noted in the IHI White Paper on Going Lean in Healthcare, "Lean experts note that the only sustainable process is one that participants believe in. The best way to create belief in a process is for participants to be able to see it in its entirety and to understand its logic. The best way to create vision and understanding is to directly involve participants in the improving process."
Engaging Patients and Families
Brandelyn Bergstedt, Program Manager, Patient Family Centered Care
Seattle Cancer Care Alliance, Seattle, WA
Engaging patients and families in their care during hospitalization is the right thing to do. Here's an easy, low-cost strategy that you can use right now. According to the Agency for Healthcare Research and Quality (AHRQ), it can also be associated with improved outcomes, patient experience, quality measures, and financial performance. When it comes to infection prevention, hand hygiene is an essential practice that appears in many healthcare-associated infection “bundles,” yet compliance is often less than reliable. Better engaging patients and families in hand hygiene has the potential to reinforce knowledge, skills and attitudes among staff, patients, and families, and, as a result, to potentially re-set the cultural expectations for hand hygiene behavior on the floor.
We Are All Infection Preventionists
Kadlec Regional Medical Center
Hand Hygiene: A Major Component of Care
Kittitas Valley Healthcare
Innovating with the frontline can be fun and rewarding. In Washington State, seven hospital floors participated in a 6-month innovation initiative with Qualis Health to test, adapt, and implement a new approach to engaging patients and families in hand hygiene during hospitalization. In addition to implementing new processes, 100% of the teams reported that they enjoyed participating in the project and will sustain it. One participant reported that "It was great to see how a small group with focused goals can make a great change." Another reported, "I was surprised how readily the hospital staff took this project on. It quickly turned into a part of patient orientation, and hopefully will continue to be..."
Learn more about the practical new processes two hospitals implemented to engage patients in hand hygiene.
The Roadmap to Engaging Patients and Families in Hand Hygiene
Tina Schwien, MN, MPH
Quality Improvement Consultant
Your hospital is ready to implement a Hand Hygiene Project. But where do you begin? The Engaging Patients and Families in Hand Hygiene Roadmap will show you the way. It takes you through eight steps to implement a program for involving patients and families in hand hygiene. Each step includes helpful tools and resources that you can either reference or download and use. Let’s get started!
Beyond the knowledge that you are building additional ways to engage patients and families in their care, consider monitoring for additional impacts. If you do, keep it simple. Identify a handful of outcomes you think will improve, such as staff hand hygiene compliance and HCAHPS RN Communication scores. For each outcome, plot the monthly value for the floor for the 12 months leading up to the project kick-off and then continue adding monthly data points throughout the project. This is called making a Run Chart. Do you see a trend developing after the kick-off? If you compute the average for the months leading up to the kick-off, is it different from the average you compute for the months following the kick-off? Is the change sustained over time? Sharing this information with leadership and the frontline team an highlight successes and breed enthusiasm for sustaining gains.
Do you want to know if the patients you engage are more likely to provide feedback? Consider using or adapting the Qualis Health 3-item patient activation in hand hygiene questionnaire.
Two of the hospital floors that participated in the Qualis Health initiative asked their Patient and Family Advisory Council (PFAC) for ideas on how to better engage patients and families in hand hygiene during hospitalization. Do you know what they learned? Patients and families do not always know what they can and can’t use in the hospital. It may be a simple thing, but letting them know it is okay and expected that they use the wall-mounted dispensers and sinks can also be very powerful. Learn more about organizing a PFAC at your organization: