Continuous improvement trumps the mythical “90%”
The shortage of actual data on handwashing compliance in healthcare has evolved into a serious industry-wide overstatement of compliance. Knowing good things happen once a 90% level is achieved, reported handwashing rates quickly climbed to that number.
Professional advancement and even bonuses are “earned”, institutionalizing a standard of bad behaviors. The Joint Commission's norm is clearly stated in their Comprehensive Accreditation Manual for Hospitals. It says nothing about 90%.
Compliance expectations are covered first in Goal 6, Standard IC.01.04.01, Elements of Performance A 5 “Improving compliance with hand hygiene guidelines.”
Under Goal 7, NPSG.07.01.01, Elements of Performance, A 3 “Improve compliance with hand hygiene guidelines based on established goals.
None the less, the 90% reward level has been hardened by years of acceptance, years without challenge.
Pursuit of improving handwashing by healthcare providers is eclipsed by the power of the status quo. Who wants to invest in improving handwashing with actual numbers when the first thing that is documented is the chronic overstatement of the past years. Facing the stark reality of a compliance level often below 50% blocks the further pursuit of hand hygiene excellence.
Kudos to The Joint Commission’s response by challenging current report levels, especially those frozen at the 90% level - “Why not 91% or 95%?” Their auditors are urging their clients to get back to a baseline of reality and restart an honest path to reduce HAIs through enhanced hand hygiene.
JACHO auditors are increasingly scrutinizing observational protocols and offer a program from their Center For Transforming Healthcare to enhance its accuracy: http://www.centerfortransforminghealthcare.org/tst_hh.aspx
The Baird Group’s patient experience experts also offer solid programs to maximize observation. Their ethnographic-based methodology is uniquely powerful and very helpful for operations striving to identify an honest baseline as a gateway for continuous improvement.
Once optimized, observational opportunities can be cost-effectively multiplied by wireless technologies. Sharp increases in the number of observations vastly improves the validity of the initiative. Realistic risk-based standards can be set and staff motivation can sustain the enhanced behaviors. http://handwashingforlifehealthcare.org/blog/mike-mann/handwashing-life-scoreboard
This matrix of features and benefits (see attachment) can be useful as a first step in evaluating alternative electronic compliance monitoring (ECM) technologies.