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IHI ExpeditionImpacting Hand Hygiene at the

Front Line Session 1

Tuesday, July 30, 2013

These presenters have nothing to disclose

Lisa Maragakis, MD, MPH

Tom Talbot, MD, MPH

Diane Jacobsen, MPH, CPHQ

Siew Lee Grand-Clément,

RN, MSN, CPHQ

Expedition Coordinator2

Kayla DeVincentis, CHES, Project Coordinator, Institute for Healthcare Improvement, currently manages web-based Expeditions and the Executive Quality Leaders Network. She began her career at IHI in the event planning department and has since contributed to the State Action on Avoidable Rehospitalizations (STAAR) Initiative, the Summer Immersion Program, and IHI’s efforts for Medicare-Medicaid enrollees. Kayla leads IHI’s Wellness Initiative and has designed numerous activities, challenges, and educational opportunities to improve the health of her fellow staff members. In addition to implementing the organization’s first employee health risk assessment, Kayla is certified in health education and program planning. Kayla is a graduate of Northeastern University in Boston, MA, where she obtained her Bachelors of Science in Health Science with a concentration in Business Administration.

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WebEx Quick Reference

• Welcome to today’s session!

• Please use chat to “All Participants” for questions

• For technology issues only, please chat to “Host”

• WebEx Technical Support: 866-569-3239

• Dial-in Info: Communicate / Join Teleconference (in menu)

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Raise your hand

Select Chat recipient

Enter Text

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Chat Time!

What is your goal for participating in this Expedition?

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Join Passport to:

• Get unlimited access to Expeditions, two- to four-month, interactive, web-based programs designed to help front-line teams make rapid improvements.

• Train your middle managers to effectively lead quality improvement initiatives.

. . . and much, much more for $5,000 per year!

Visit www.IHI.org/passport for details.

To enroll, call 617-301-4800 or email improvementmap@ihi.org.

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What is an Expedition?

ex•pe•di•tion (noun)

1. an excursion, journey, or voyage made for some specific purpose

2. the group of persons engaged in such an activity

3. promptness or speed in accomplishing something

Expedition Support

All sessions are recorded

Materials are sent one day in advance

Listserv address: HandHygiene@ls.ihi.org

– Sends an email to all participants and faculty

– Use only for questions relevant to all participants

– To add yourself or colleagues, email us at info@ihi.org

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Where are you joining from?

Expedition Director10

Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement (IHI) is currently directing the CDC/IHI Antibiotic Stewardship Initiative, NSLIJ/IHI Reducing Sepsis Mortality Collaborative. Ms Jacobsen served as IHI content lead and improvement advisor for the California Healthcare-Associated Infection Prevention Initiative (CHAIPI) and directed Expeditions on Antibiotic Stewardship, Preventing CA-UTIs, Reducing C. difficileInfections, Sepsis, Stroke Care and Patient Flow. She served as faculty for IHI’s 100,000 Lives and 5 Million Lives Campaign and directed improvement collaboratives on Sepsis Mortality, Patient Flow, Surgical Complications, Reducing Hospital Mortality Rates (HSMR) and co-directed IHI's Spread Initiative She is an epidemiologist with experience in quality improvement, risk management, and infection control in specialty, academic, and community hospitals. A graduate of the University of Wisconsin, she earned her master's degree in Public Health-Epidemiology. from the University of Minnesota.

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Today’s Agenda11

Ground Rules & Introductions

Pre-Program Survey Results

Call to Action for Hand Hygiene

The Joint Commission Targeted Solutions Tool

Using the Model for Improvement

Action Period Assignment

Ground Rules12

We learn from one another – “All teach, all learn”

Why reinvent the wheel? – Steal shamelessly

This is a transparent learning environment

All ideas/feedback are welcome and encouraged!

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Overall Program Aim

To provide hospitals with practical change ideas and innovative approaches to impact Hand Hygiene at the frontline in their organization

Expedition Objectives

By the end of the Expedition participants will be able to:

Describe the impact of hand hygiene on healthcare-associated infections

Discuss methods for measuring effectiveness of hand hygiene in your organization and creative approaches to assessing your progress over time

Identify and begin improving at least one key process to increase hand hygiene focus and practice in your hospital

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Schedule of Calls

Session 1 – Call to Action for Hand HygieneDate: Tuesday, July 30, 2:30 PM – 4:00 PM ET

Session 2 – Measurement ApproachesDate: Tuesday, August 13, 2:30 PM – 3:30 PM ET

Session 3 – Supplies, Equipment, and the EnvironmentDate: Tuesday, August 27, 2:30 PM – 3:30 PM ET

Session 4 – Leadership and Culture for Hand HygieneDate: Tuesday, September 10, 2:30 PM – 3:30 PM ET

Session 5 – Frontline EngagementDate: Tuesday, September 24, 2:30 PM – 3:30 PM ET

Session 6 – Marketing and Communications Campaigns

Date: Tuesday, October 8, 2:30 PM – 3:30 PM ET

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Faculty16

Lisa Maragakis, MD, MPH is an Assistant Professor of Medicine at The Johns Hopkins University, Department of Medicine, Division of Infectious Diseases and the Hospital Epidemiologist and Director of the Department of Hospital Epidemiology and Infection Control at The Johns Hopkins Hospital. She received her medical degree and post-doctoral Infectious Diseases training at The Johns Hopkins University School of Medicine and a master’s degree in public health from The Johns Hopkins University Bloomberg School of Public Health. She recently served as a Councilor on the Board of Directors of the Society for Healthcare Epidemiology of America (SHEA), as Vice-Chair of the SHEA Guidelines Committee and as the liaison representing SHEA to the Healthcare Infection Control Practices Advisory Committee at the Centers for Disease Control and Prevention. Her research interest is the epidemiology, prevention and control of healthcare-acquired infections caused by antimicrobial-resistant gram negative bacilli.

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Faculty17

Tom Talbot, MD, MPH, FSHEA, FIDSA, Associate Professor of Medicine and Preventive Medicine, Vanderbilt University School of Medicine and Chief Hospital Epidemiologist, Vanderbilt University Medical Center, conducts research on healthcare epidemiology and infection control and oversees healthcare-associated infection prevention programs. Dr. Talbot currently serves as a member of the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC).

Pre-Program Survey Results

Diane Jacobsen,

MPH, CPHQ

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Poll Question – Who is in the room?

Please select the roles or departments represented on the call today from your organization. Check all that apply:– Nursing

– Physicians

– Infection Prevention

– Quality Improvement

– Leadership

– Pharmacy

– Allied Health Professional

Please chat any additional roles into the chat box.

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Survey Results:Top Barriers to Improving Hand Hygiene

1. Lack of accountability or enforcement of compliance.

2. Staff are unaware of importance or proper procedure.

3. Leadership does not support hand hygiene campaigns or activities.

4. Sanitizer or sinks not reliably stocked and poorly located.

5. Staff are not engaged or supportive of hand hygiene activities.

6. Staff are too busy and do not have time to properly wash hands.

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Survey Results:Measurement Approaches

Direct Observation

– Secret or Embedded Observers: 87%

– Unit Representatives Who Observe Own Unit Practice: 60%

Sanitizer Consumption: 14%

Healthcare-associated Infection Rate: 30%

– As a surrogate outcome

Technology for Electronic Monitoring: 6%

– Including RFID

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Survey Results:Average Hand Hygiene Compliance

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80% or greater

60%-80%

40%-60%

Less than 40%

Not sure

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Call to Action for Hand Hygiene

Lisa Maragakis, MD, MPH

Healthcare-associated Infections and Resistant Organisms

Central line-associated bloodstream infections (CLABSI)Surgical Site Infections (SSI)Ventilator-associated pneumonia (VAP)Catheter-associated urinary tract infection (CAUTI)Methicillin-resistant S. aureus (MRSA) Vancomycin Resistant Enterococcus (VRE)Multidrug resistant Gram negative bacilliClostridium difficile

InfluenzaRespiratory Syncytial Virus (RSV)VaricellaTB

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How Do We Prevent HAIs and MDRO Transmission?

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Hand hygiene

Standard and isolation precautions

Evidence-based best practices

Surveillance/ data feedback

Immunizations

Cleaning, disinfection, sterilization

Antimicrobial stewardship

Hand Hygiene Indications

Upon entering and exiting a patient roomBetween patient contacts if >1 patient in a roomBefore and after touching a patient who is not in a room (on a stretcher or wheel chair in the hall)Before donning and after removing glovesBefore handling invasive devicesAfter contact with blood or body fluids or excretions, mucous membranes, non- intact skin or wound dressingsAny time needed such as after sneezing, or coughing before handling food or oral medications to patient roomBefore & after touching wounds

Soap and water required AFTER care of patient on isolation for C. difficile or Norovirus

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A Sobering Letter…

“Today would have been my beloved wife’s birthday. She died in your hospital…”

…“I witnessed many gross violations... not limited to one building, one floor, or one individual. …staff with colds coughing and sneezing in my wife's room without masks on…doctors not washing their hands upon entering the room, … they replied that these were simply ‘guidelines’, and that the staff person could opt to proceed at their own risk…..”

Line Insertion Line Maintenance

1. Perform hand hygiene before and after catheter

insertions or manipulation

2. Use chlorhexidine for skin

preparation2. Hub care

3. Use full barrier precautions

during insertion 3. Site care

4. Avoid using the femoral

site in adult patients4. Tubing care

5. Assess the need for the catheter each day and remove

ASAP

Best Practices to Prevent CLABSI

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Best Practices to Prevent SSI

Clean hands (surgical scrub)

Use antimicrobial prophylaxis when indicated

– Right time (within 1 hour of incision)

– Right dose

– Right agent

– Appropriate duration

Chlorhexidine skin prep applied correctly

Clippers for hair removal (not razors)

Control glucose and temperature

Use appropriate FIO2

Best Practices to Prevent VAP

Hand hygiene

Elevate the head of the bed >30 degrees

Oral care with chlorhexidine

Sub-glottic suctioning ET tube

Sedation vacation

Daily assessment of readiness to wean

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Respiratory Etiquette

Clean hands

Cover your sneeze

Get immunized (flu vaccine)

Immunize your patients for flu and pneumococcus

Wear a mask if you have a cold

Do not work if you have influenza-like illness or any febrile respiratory illness

Does hand hygiene work?

YES!! Alcohol hand rub and old fashioned hand washing work well

Reduces organisms on HCW hands

Reduces infection rates

Reduces mortality

Doebbeling 1988, AIM:109;394-8Larson 1988, ICHE:9;28-36Pittet D, et al. Lancet 2000;356:1307-1312.

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Ignaz Philipp Semmelweis (1818-1865)

Post-Partum Mortality Intervention Trial

0.0%

5.0%

10.0%

15.0%

20.0%

Before After

Physicianward

Midwifeward

Two wards, each with 3500 deliveries/year� Physicians and medical

student– 600-800 mothers died/year

� Midwives– 60 mothers died/year

Intervention: Rub hands in chlorinated lime solution until slippery and cadaver smell gone before every vaginal exam

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Infection Rates with Improved Hand Hygiene

0

0.1

0.2

0.3

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0.7

1993 1994 1995 1996 1997 1998

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RS

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15

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35

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MRSA incidence

NosocomialInfections

Pittet, Lancet 2000; 356: 1307-12

• Alcohol hand rubs and hospital-wide campaign to increase HH compliance• Improved HH compliance (48% to 66%)• Decreased

� MRSA incidence (2.16 to 0.93 episodes per 10,000 patient days) � Overall healthcare-associated infections (17% to 10%)

0%

10%

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30%

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80%

90%

100%

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-10

Hand Hygiene Compliance

Hand Hygiene Compliance

Hand Hygiene Compliance

Hand Hygiene Compliance

MRSA Transmission Rate Per 1,000 Pt. Days

MRSA Transmission Rate Per 1,000 Pt. Days

MRSA Transmission Rate Per 1,000 Pt. Days

MRSA Transmission Rate Per 1,000 Pt. Days

MRSA Rate (Per 1,000 Pt Days)MRSA Rate (Per 1,000 Pt Days)MRSA Rate (Per 1,000 Pt Days)MRSA Rate (Per 1,000 Pt Days) HH ComplianceHH ComplianceHH ComplianceHH Compliance

Linear (MRSA Rate (Per 1,000 Pt Days))Linear (MRSA Rate (Per 1,000 Pt Days))Linear (MRSA Rate (Per 1,000 Pt Days))Linear (MRSA Rate (Per 1,000 Pt Days)) Linear (HH Compliance)Linear (HH Compliance)Linear (HH Compliance)Linear (HH Compliance)

HH vs. MRSA Transmission Rate for JHH Adult ICUsOctober 2007 to June 2010

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Profession Compliance

Registered Nurses 26%

Physicians 21%

Nurses Aides 14%

Respiratory Therapists 10%

Radiology Technicians 0%

Environmental Staff Services 0%

Medical Students 83%

Hand Hygiene Compliance by Profession

Kim P. Am J Infect Control April 2003

Pittet, Ann Intern Med, Jan 19, 1999; Boyce Editorial

Why is Compliance So Poor?

Skin dryness and irritation with frequent washing

No time to wash hands (too busy)

Inconvenient sink location

Adherence not typically tracked individually – no records kept

Not rewardedAdverse events aren’t immediate and their relationship to the missed HH opportunity isn’t always clear

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Another Sobering Letter….

Dear Editor: “The editorial on hand washing calls for all hospital staff to start regularly washing their hands between each patient contact. If, as the authors claim, there is such compelling evidence for the need to wash hands between each patient contact then why do I and the vast majority of my colleagues not do it? Firstly, I have never seen any convincing evidence that hand washing between each patient contact reduces infection rates…. Secondly... Washing hands between eachcontact (at 1-2 minutes per wash) would take on average 1-2 hours.Where will this time come from, and who will fund it? If hand washing is to be performed between every patient contact then it would have major resource implications. For this it needs to be shown to be effective and worth the 15% extra staffing that would be needed to cover the extratime.”

-Andrew Weeks, specialist registrar in obstetrics and gynaecology BMJ 1999

Pittet D. Ann Intern Med 1999

Correlation Between High Workload and Lower HH Compliance

Ward 20-40 opp/ hr care

ICU 43 opp/ hr care

Decrease of compliance by 5% per 10 opportunites per hour

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So is there any good news??

Yes!

Multifaceted interventions; rigorous monitoring and feedback; rewards, recognition, and accountability can lead to improvements and good HH performance

Improvement requires perseverance, dedication, engagement, leadership support, creativity and adaptability

Hand Hygiene Compliance for JHH: January 2009 – May 2013

0%0%0%0%

10%10%10%10%

20%20%20%20%

30%30%30%30%

40%40%40%40%

50%50%50%50%

60%60%60%60%

70%70%70%70%

80%80%80%80%

90%90%90%90%

100%100%100%100%

Hand Hygiene Compliance

Hand Hygiene Compliance

Hand Hygiene Compliance

Hand Hygiene Compliance

CY CY CY CY 2013 2013 2013 2013 Goal: 90%Goal: 90%Goal: 90%Goal: 90%

Hospital Mean: 91%Hospital Mean: 91%Hospital Mean: 91%Hospital Mean: 91%

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Hand Hygiene

Is the cornerstone and of upmost importance to our infection prevention efforts

Leads to decreased HAIs and MDRO transmission

Is difficult BUT POSSIBLE to achieve

SHEA, IDSA and their partners are in the process of updating the Compendium of Strategies to Prevent Healthcare-associated Infections which will include a new section on Hand Hygiene

Questions?44

Raise your hand

Use the Chat

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Faculty45

Siew Lee Grand-Clément, RN, MSN, CPHQ, Center Solutions

Development Director, the Joint Commission, leads solution

development activities for the Joint Commission Center for

Transforming Healthcare. A Black Belt in Robust Process

Improvement, she also serves as an RPI instructor and Mentor of

Yellow Belts, Green Belts, and Black Belts. Prior to her current role,

Siew Lee was the Associate Director of International Accreditation

for Joint Commission International (JCI). Siew Lee brings extensive

experience and diverse knowledge in nursing, staff training and

development, and healthcare quality to her role at the Joint

Commission. She has worked in multiple adult clinical areas in both

small community hospitals and large academic medical centers.

Siew Lee received her Bachelor of Science in Nursing with a minor

in Community Health from University of Central Oklahoma, and her

Master of Science and Advanced Practice Nursing training from

Johns Hopkins University.

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The Joint Commission Center for Transforming Healthcare

Hand Hygiene Targeted Solutions Tool (TST)

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Introduction to CTH-Vision

All people always

experience the safest,

highest quality, best-value

health care across all

settings.

One Vision

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Our Mission: Transform health care into a high reliability industry

and to ensure patients receive the safest, highest quality care.

Leadership

• The responsibility of leadership to make high reliability the priority

• The responsibility of leadership to make high reliability the priority

Safety Culture

• The importance of creating a culture of safety within an organization

• The importance of creating a culture of safety within an organization

RPI

• The use of proven quality methods – Lean Six Sigma & Change Management (known together as robust process improvement™) – to systematically improve processes and avoid common, crucial failures

• The use of proven quality methods – Lean Six Sigma & Change Management (known together as robust process improvement™) – to systematically improve processes and avoid common, crucial failures

Introduction to CTH- Mission

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Robust Process Improvement™(RPI)

RPIRPI

Many causes of the same problem

Many causes of the same problem

Key causes different

from place to place

Key causes different

from place to place

Each cause requires a different strategy

Each cause requires a different strategy

New Generation of Best Practices:Complex processes require RPI to produce solutions – customized to an organization’s most important causes

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� Systematic approaches to problem solving proven in many other spheres of work

– Lean, six sigma, change acceleration, Toyota

– Different from what came before (CQI, TQM)

� Equally effective when applied to our toughest safety and quality problems

� Directly address critical failings of current QI

� Appealing to physicians and other clinicians

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Project 1: Improving Hand Hygiene Compliance

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Joint Commission

CTH Black Belt

&

Master Change Agent

Cedars-Sinai

Exempla

Froedtert

JohnsHopkins

Memorial Hermann

Trinity

Health

Virtua

Wake

Forest

Each letter = one hospital

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Confidential ● Easy to Use ● No Extra Cost

Separate from Accreditation

• Educational, no jargon, no special training and no knowledge of RPI methodology needed

• Guides users to customized solutions. Data analysis conducted by the tool, not the user. Tool walks user through process of:

� Measuring current state

� Determining root causes

� Selecting targeted solutions

� Control of process after implementation

SPREADMECHANISM

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Highly Reliable Solutions

Healthcare Avoidable Conditions In TST In Progress

CLABSI X

Adverse Drug Events

Pressure Ulcers

Injuries from Falls

CAUTI X

Ventilator Associated Pneumonia X

Surgical Site Infections

Venous Thromboembolism

Obstetric Adverse Events

Preventable Readmissions X X (new: heart

failure)

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X

X

X

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Value Impact StudyValue Impact StudyValue Impact StudyValue Impact Study

Hand HygieneHand HygieneHand HygieneHand Hygiene

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Over One Million Observations!

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48%

58%

47%

81% 83%

64%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Participating Hospitals (First 8) TST US Health Care Organizations TST International Health CareOrganizations

Baseline Post Improvement

N = 12,643

N = 101,179

Analysis of ResultsOverall Hand Hygiene Compliance, US and International

Center Update - 55

June 19, 2013

N = 503,991

Percent Change in Compliance: 43%

Improvement

N = 12,184

Percent Change in Compliance: 34%

Improvement

Percent Change in Compliance: 71%

Improvement

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For a typical 200-bed hospital, the TST for hand hygiene could save 8 lives and $2.3-$2.8M per year

Note: (†) Assumes a 35% reduction in HAIs through a hospital-wide implementation of the TST for hand hygiene, based on the impact of 5 published studies (Refs 1-5)Sources: [1] Pittet (2001) J Hosp Inf, S40-S46; [2] Lam (2004) Pediatrics, e565-571; [3] Won (2004) Inf Cont Hosp Epid, 742-746; [4] Pessoa-Silva (2007) Pediatrics, e382-e390; [5] Rosenthal (2005) Am J Inf Cont, 392-397; [6] Figures adjusted to 2011 dollars using consumer price index - CDC "The Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Prevention," R. Douglas Scott II, March 2009; [7] Based on 1.7M HAIs contracted annually and 944K US hospital beds – AHA, 2011 [8] CDC – HAI mortality rate of 5.8%

TST can prevent ~65-70 HAIs for every 100 beds†

# of HAIs / 100 beds / year

200

150

100

50

0

120

-65-70

After TSTBefore TST7

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$2.3-2.8 millionCosts that could be saved

HAIs cost $18-21K per infection in direct medical costs6

130-140Number of HAI

cases that could be

prevented

8Lives could be saved

HAIs have a 5.8% mortality rate8

A typical 200-bed hospital can expect significant benefits by implementing the TST tool

Hand hygiene

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www.centerfortransforminghealthcare.org

Demo of Hand HygieneHand HygieneHand HygieneHand Hygiene

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TST – Step 1 Getting Started

Tips from Experts

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Defining Hand Hygiene -2 moments

Link to CDC & WHO

guidelines

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TST – Step 2 Training Observers

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Downloadable training materials/ videos & competency exam

Scenario videos and practice with the data collection form

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Data Collection MethodHH data collector (observer) Just-in-time coach

Purpose To be an unbiased observer for hand hygiene compliance.

To intervene when hand hygiene non-compliance is observed and coach staff on proper compliance.

Data collected

Hand hygiene compliance data is used for establishing the baseline Hand Hygiene performance

Data collection will begin after the baseline data has been collected and the compliance data shared with staff.

Secret shoppers”: anonymous observers collected data on physical barriers of non-compliance without influencing the observed behaviors.

JIT coaches capture non-observable cultural barriers by interviewing health care providers after an observed instance of non-compliance.

Who

Using staff in a position where they can secretly observe staff while performing their regular job duties and not seem out of place during their time on the unit.Example: housekeeping and lab staff, chaplains, volunteers.

Approach staff when defects (non-compliance) occur and have staff to explain how the defect occurred since some defects cannot be observed (i.e., distractions, skin irritation). Example: unit managers, charge nurses, infection control practitioners, executives/leadership, and quality coaches or unit-based educators.

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Observable versus Non Observable Contributing Factors

TST- Step 3 Measuring Compliance

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TST – Step 4 Determining Factors

Real-timeAnalysis &

data feedback

Filtering capabilities to drill down for root causes

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�Gloves

�Hands Full of Supply

�Follow Exit/Entry

�Frequent Exit/Entry

�Hands Full of Supply

�Follow Exit/Entry

�Gloves

�Distracted

TST Step 4: Validated Contributing Factors

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TST Step 4: Driving Acceptance & Accountability

Analysis of Mean:

Wash IN

&

Wash OUT

Compliance by

Health Care Provider

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TST Step 5: Implementing Solutions

Targeted Solutions to Root Cause

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Downloadable Solutions Guide

•Project checklist•Implementation guide

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TST Step 6: Sustaining the Gains

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Memorial Hermann’s Story: Getting to Zero

�Leadership committed to high reliability

�Embarked on culture change initiative

�MH Woodlands Hospital was among the 8 Center hospitals in first hand hygiene project

�2010: MH committed to use TST to improve hand hygiene system-wide (12 hospitals)

�Baseline (150 inpatient units) = 44%

– Range (12 hospitals): from 21% to 65%

– Aim: to exceed 90%

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Memorial Hermann: Summary System-wide HAI reductions using TST

Baseline Control

(pre-TST) (post TST) Relative

Oct 2010- Jan-June Decrease

May 2011 2012 (%)

Adult ICU BSI1 0.79 0.45 43

NICU BSI1 1.85 1.07 42

VAP2 0.95 0.5 471 BSI per 1000 line days 2 VAP per 1000 ventilator days

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Michael Shabot, MDMemorial Hermann System CMO

“We fully attribute to the Center for Transforming Healthcare’s hand hygiene [tools] the final drop in HAI rates to zero or near-zero system-wide. After implementing CTH hand hygiene, our hospitals began to report zeros as their most common monthly CLABSI and VAP result. Our mothers were right after all! Feel free to quote me. This actually saves lives.”

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International Hand Hygiene TST

pilot cohortAsia Pacific (3):

1. The Medical City, Pasig City, Philippines

2. Institute Jantung Negara in Kuala Lumpur, Malaysia

3. Premier Jatinegara Hospital, Jakarta, Indonesia

Middle East (4):1. National Center for Cancer Care & Research, Doha, Qatar2. King Faisal Specialist Hospital & Research Centre, Jeddah,

Saudi Arabia3. King Faisal Specialist Hospital & Research Centre, Riyadh,

Saudi Arabia4. Sheikh Khalifa Medical City, Abu Dhabi, UAE

Europe (2):1. Azienda Ospedaliero

Universitaria (S Maria della Misericordia) di Udine, Udine, Italy

2. UZ Leuven, Leuven, Belgium

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How do I Access the TST?

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Using the Model for Improvement

Diane Jacobsen,

MPH, CPHQ

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What are we trying toaccomplish?

How will we know that a

change is an improvement?

What change can we make that

will result in improvement?

Model for Improvement

Act Plan

Study Do

Aim of Improvement

Measurement of

Improvement

Developing a Change

Testing a Change

Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass, 1996.

Why Test?

Increase the belief that the change will result in improvement

Predict how much improvement can be expected from the change

Learn how to adapt the change to conditions in the local environment

Evaluate costs and side-effects of the change

Minimize resistance upon implementation

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Plan• Compose aim

•Pose questions/predictions

•Create action plan to carry

out cycle (who, what, when,

where)

•Plan for data collection

DoStudy

Act

• Carry out the test and

collect data

•Document what occurred

•Begin analysis of data

• Complete data analysis

•Compare to predictions

•Summarize learning

• Decide changes to make

•Arrange next cycle

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Testing on a Small Scale

RULE OF ONE: Conduct the test on one unit, with one staff member or physician and one patient

Conduct the test over a short time period

Test the change on a small group of volunteers

Develop a plan to simulate the change in some way

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Repeated Use of the PDSA Cycle

Hunches

Theories

Ideas

Changes That

Result in

Improvement

A P

S D

A P

S D

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

Sequential building of

knowledge under a

wide range of

conditions Spread

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Questions?82

Raise your hand

Use the Chat

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Action Period Assignment

Complete 3 to 5 hand hygiene observations on one unit using the data collection tool provided by the Joint Commission (will be distributed on the listserv after the call) OR your organization’s current data collection tool– If using the Joint Commission tool, Watch “Improving Care with

Targeted Solutions Tool (TST)” video (6 minutes) http://www.centerfortransforminghealthcare.org/multimedia/improving-care-with-the-tst/

Based on what you observed, brainstorm ideas you could test to address current barriers to hand hygiene– Consider: visibility and availability of soap, visual reminders or

prompts, workflow obstacles related to availability and location of supplies, pace on the unit, etc.

Come prepared to share your experience at Session 2.

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How do I Access the TST?

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Expedition Communications

Listserv for session communications: HandHygiene@ls.ihi.org

To add colleagues, email us at info@ihi.org

Pose questions, share resources, discuss barriers or successes

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Next Session

Tuesday, August 13, 2:30 PM – 3:30 PM ET

Session 2 – Measurement Approaches

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