Senior executives play a pivotal role in implementing patient safety and hand hygiene initiatives, yet little research has been conducted on their views regarding how to improve outcomes and increase compliance, according to a study published in BMC Infectious Diseases.
To gain more insight into healthcare executives' views, researchers conducted face-to-face interviews with 13 senior executives at a major teaching and referral hospital in Sydney, Australia.
During their discussions, the executives expressed numerous ideas to improve hand hygiene compliance, including novel concepts and suggestions to modify existing strategies. Their ideas, as outlined by the study, are listed below.
1. Fostering a culture change starts with a top-down approach. Senior clinical and non-clinical leaders alike need to "visibly champion and mandate best practice initiatives" and clearly communicate that non-compliance is unacceptable.
2. Refresh the content, focus and modes of delivering the message. Education, signage and reminders based on the World Health Organization's Five Moments for Hand Hygiene need to be refreshed to avoid losing their impact or becoming "stale."
3. Hand hygiene principles and programs should be addressed throughout the patient journey. Because many staff members interact with patients in a non-clinical way, WHO's Five Moments didn't always seem reasonable. To improve compliance, leaders should tailor programs to specific healthcare work settings.
4. Overhaul hand hygiene audits. All senior leaders expressed dissatisfaction with the over-simplified, outdated audits that hindered efforts to use audit data to create actionable changes. Participants argued audits should be able to disseminate data more quickly and should be organized by departments or clinical units in reports.
5. Engage and empower patients to be more involved. Leaders can implement hospital-wide approaches to encourage patients to remind healthcare workers to wash their hands and to train staff members how to respond to such requests from patients.
6. Decide how to categorize non-compliance. Participants expressed varying perspectives when it came to whether non-compliance should be regarded as a medical error (not dissimilar to giving a patient the wrong medication) or simply as resulting from lack of time and awareness.
7. Determine appropriate consequences for non-compliance. The leaders interviewed for the study also expressed varying views on how to penalize repeated non-compliance. Suggested approaches included financial penalties, linking accreditation to compliance, introducing performance management or implementing a graded or tiered approach to managing noncompliance.
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Face touching is a habit: Raise awareness to raise hand hygiene compliance