Ohio State University
||Joining the university’s medical center in a two-year hand hygiene improvement initiative|
Columbus, Ohio, USA
||Allied Health Professions, Health Policy, Health Sciences, Healthcare Administration, Law, Medicine, Pharmacy, and Public Health|
||Dr. Susan Moffatt-Bruce, Alexander Cherry, Iahn Gonsenhauser|
About the project: The Chapter was heavily involved in a project to improve hand hygiene compliance at the Wexner Medical Center at Ohio State University. (The work was part of a two-year collaborative led by the Ohio Hospital Association and the Central Ohio Hospital Council.) Students worked to improve the data collection and audit tools the institution used. More specifically, students managed and conducted observations in the hospitals, and took part in developing coaching strategies to encourage staff members to increase hand hygiene compliance. Compliance rates rose from 47% to 86%.
Faculty Advisor Dr. Susan Moffatt-Bruce and Chapter Leader Iahn Gonsenhauser share more on how to successfully integrate a Chapter into ongoing improvement work in a health care setting.
What training did the students receive as they joined the project?
SMB: We had a combination of nursing and medical students from the Chapter go out on the ward and do audits for hand hygiene compliance. There’s a standardized audit tool that they had to learn. They also had to learn about coaching and how to approach somebody with positive intent. Additionally, they had to understand appropriate data collection and learn that you need to have a critical number of observations in order to make that data valid.
What other skills did students gain by participating?
IG: Throughout the experience, students were learning a lot about project management. They learned about personnel management, data management, and the most efficient, effective way to organize the workloads. They also had to find ways to get the data to the parties who were supposed to be receiving it in the quality and operation departments.
What strategies were used to increase hand washing among staff?
SMB: You have to use a lot of different strategies.
First, we had students doing audits so we could identify what groups of people weren’t washing their hands.
Secondly, we developed ways to coach people. Sometimes that just meant handing out hand hygiene products. (Sometimes you don’t have to say much; you just give them hand sanitizer.)
And, on two occasions, we had what’s called a Stand Up for Hand Hygiene when the entire medical center stopped for 30 minutes. Everybody stopped and there was an overhead announcement urging each unit to come up with a strategy to improve hand hygiene. It might be a funny sign. Or some people put a little cookie jar out and if they found somebody who wasn’t washing his hands they had to put a dollar in it. Each unit, during that time, came up with a solution and then sent it to us in the quality department so we could get a sense of what everybody was doing.
Last, but not least, we have identified and charged one physician, one nurse, and one staff person on each unit to do weekly observations and coaching on their team. And then we passed out their scores, quite publicly, each month. It was a bit of a competition.
What do you think was one of the most important keys to success in this project from the Chapter’s point of view?
IG: I think, for us, our biggest assets in all of these projects and all of our functions as an IHI Chapter here is our faculty champion which we find in Dr. Moffatt-Bruce. She is our gate keeper to all of the people who hold these projects in their agenda. She’s the person who aligns us with these projects and helps us get and stay involved. I have always stressed this about the Chapters. The greatest necessity in Chapters is having a strong faculty champion — and she’s exactly that.
What are some of the long-term benefits that you see as a result of the project?
SBM: When you assign responsibility to a group, especially physicians, it can take a long time to get them to be champions, as well. It’s one thing for students or for nurses to be champions, but it’s a much more difficult thing to get doctors to be responsible. That took a lot longer.
IG: I know the residents that we have now who were involved in some of these projects and then stayed at Ohio State in the program continue to be some of the champions of quality improvement. Just being involved in these projects empowers people as agents of change.