Hand Hygiene Task Force members

In just six months, the Brigham increased its hand hygiene compliance rate from 67 to 90 percent, thanks to a clear mission, committed leadership, an efficient team structure, comprehensive communication and analytics, and the ongoing efforts of local leads, frontline staff and support services. That said, we still have work to do. Brigham Bulletin recently sat down with Charles A. Morris, MD, MPH, associate chief medical officer and Hand Hygiene Task Force member, to talk about what our “For All the Lives We Touch” campaign has accomplished to date and how it’s paving the way for lasting cultural change.

Q: What has it been like to work on the hand hygiene campaign this past year?

CM: It’s been a tremendous opportunity to co-lead a high-visibility project with Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services, and Julia Sinclair, MBA, senior vice president of Clinical Services. This project has great alignment with hospital priorities and, of course, watching the remarkable success of the campaign has been very fulfilling.

Q: How has the Brigham demonstrated leadership throughout this campaign?

CM: We would not be where we are without the tremendous investment and energy of countless others. Time and again, when Maddy, Julia and I and the other members of the Hand Hygiene Task Force have been wrestling with an obstacle, we’ve elected to turn it back over to local leaders to brainstorm, solve and implement a solution that works for them — and then we ask them to share with the entire group so we all benefit from that solution. The Department of Surgery, for example, figured out how to engage residents in observing hand hygiene while fulfilling Accreditation Council for Graduate Medical Education-required participation in a process improvement project. This may, in turn, become a template for other departments. Having such a strong presence of local leadership has been rewarding to watch and critical to the success of this work.

Q: What feedback have you received from faculty and staff over the past six months?

CM: We’ve been hearing great feedback that the messaging is connecting and resonating. We’ve also been challenged on our assumptions in provocative and productive ways. For example, Post-Anesthesia Care Unit staff told us that a major barrier to hand hygiene was the inaccessibly of sanitizer pumps, even though it looked like there were adequate numbers. Local leaders worked with our Facilities teams and helped to craft a workable solution with more dispensers affixed to tables. Other groups, including our Inpatient Services and Emergency Department staff, have struggled with our observation platform and have been instrumental in communicating those pain points to us. We’ve also gotten clear feedback that recognition matters — we’ve tried to routinely reward groups that are pushing performance and compliance, whether that’s with a team pizza party, staff recognition photos on PikeNotes or our upcoming hand hygiene celebration on May 2 (see box below).

Q: How will we sustain this work in the months ahead?

CM: It’s going to be an ongoing challenge. We must work together to keep it visible, whether that’s through digital signage, videos, celebrations or other internal messaging. Achieving a goal is one challenge; sustaining that performance as newer, competing priorities emerge poses a different opportunity. We simply need to make it everyone’s priority. As Maddy often asks, “How do we make hand hygiene muscle memory?”

So far, we’ve engaged people across all groups, including primary clinical teams and ancillary supporting groups. Previously, we targeted clinical teams who have a direct role in patient care and contact, and we had focused less on groups that were only entering a room but did not otherwise have patient contact. We realized sustaining this work necessitated one standard for everyone, and that became the expectation for hand hygiene each time someone entered or exited a room, regardless of activity, role or intent. This has meant engaging with groups that have not been involved in clinical initiatives before, and they have responded in extraordinary ways. Food Services, for example, has transformed their approach to hand hygiene, and as a result has enviable performance from which we’re all learning.

Q: How does the hand hygiene campaign set the stage for similar strategic work?

CM: We plan to broaden our current efforts to include other hospital-acquired condition and quality goals this year. We’re applying our hand hygiene frameworks and lessons learned to our planning efforts for reducing catheter-associated urinary tract infections and central line-associated bloodstream infections, for example, which we’ll share more about in the coming months.

I think these initiatives are perfectly aligned with a few of our newly stated values. Above all, hand hygiene is about caring for our patients, which means doing right by and for them — simply put, we care. We achieve our goals through a collective effort and, as stated in another newly articulated value, we’re stronger together. There is no way to achieve this kind of success unless everyone in our community is committed and working in lock-step with one another. A critical component to this is feedback — how do we want to tell others they’ve missed an opportunity for hand hygiene, and how do we want to receive that feedback ourselves? I think transforming our culture by creating an environment where that kind of respectful, constructive feedback is freely shared and received will be foundational for many other initiatives going forward.