Commitment Instead of Compliance: A Secret of Success and Sustainability for the Hand Hygiene Program
Methods: A program based champion model (one person from each of the hospital programs) was trained and allocated on the weekly bases to perform hospital wide auditing by direct observations. Just in time education and feedback by the auditors was given to healthcare providers for all the missed opportunities. A standardized provincial tool was used to collect and record observation data. The observation data was summarized using an access database and broadcasted hospital wide by-weekly, monthly and quarterly. An average of 1725 observations was collected on the weekly basis and broadcasted hospital wide. A year end data was reported publicly on hospital website.
A positive reinforcement strategy was used to commend clinical areas with the best results. Certificates were handed by CEO to leaders of clinical areas that performed at or above the target level.
Results: The ongoing observations, feedback and attention to the hand hygiene resulted in a significant and sustained improvement. The target was raised and achieved three times over the five year period: year one and two target - 80% to 85%; year two and three target - 85% to 90%; year five target - 90% to 95%.
Conclusion: In five years since the beginning of the project, the adherence to Hand Hygiene increased to 95%. We were able to demonstrate that high priority patient safety initiatives require positive reinforcement and consistent ongoing effort over several years. The organizational commitment can be translated to the increased and sustained compliance over time.