Alfred North Whitehead, a noted English mathematician and philosopher, once said, “Simple solutions are seldom simple.” This quote resonates with me, particularly as I think about the work I have done throughout my career in health care. I am struck by how often something has sounded simple, but once I started digging a little deeper into the issue, I found that reaching a solution was not simple at all. In fact, solving the “simple” problem often involved days of work, discussions with many people, and a thorough review of what others had already done to ultimately solve the problem.
From my experience in solving many of these “simple” problems, a couple of effective strategies have surfaced over the years. These approaches have made reaching solutions easier and in the long run, have resulted in relatively successful outcomes. I hope that as an organization, we can apply these methods to solving a problem we face today: our quest to reduce hospital-acquired infections through the “simple” act of improving hand hygiene compliance.
It sounds like a pretty easy solution to use alcohol-based sanitizing gel or to wash our hands each time we enter and exit a patient’s room, doesn’t it? However, we have discovered that the act of washing our hands, just like our mothers always told us, is something easier said than done! UTMB is still struggling to get all of our physicians, nurses and staff to perform at the current target of 90% hand hygiene compliance, let alone reach 100% compliance. Although we all agree that we should be at 100%, we haven’t been able to move the needle—so what will that take?
So far at UTMB, we have attempted to solve the issue of hand hygiene using an overall institutional approach. Although we have made some considerable improvements from where we started several years ago, this year we have hit a plateau that continues to hover below our goal. Despite a new communications campaign and reinvigorated training efforts, we have made very little progress.
I have found that the best way to tackle a problem like this and find the best solution is to gather a strong representation of everyone who is affected, present the issue at hand, and through collaborative discussion, explore the various facets of the problem until a solution gradually emerges. The power of this synergistic process is that everyone brings different strengths and perspectives to the table, especially when they are not within the boundaries of their assigned department, unit or clinic—in other words, they are out of their silo and working in an integrated way. When people are allowed to freely collaborate, they arrive at some pretty practical, sometimes elegant, solutions to the problem(s) in front of them.
As a leader, it is important to realize that facilitating a collaborative discussion does not mean that we are expected to already have all of the answers immediately at our fingertips. In fact, sometimes if we know too much, it can actually inhibit the collaborative process. Marshall Goldsmith, a noted speaker and writer on leadership, suggests that the biggest mistake a leader can make is to “add too much value”. When a leader contributes too much too quickly, they can actually stifle discussion and collaboration. When that happens, the group does not get to the best solution, and sometimes they cannot reach a solution at all.
Instead, the role of the leader is to spearhead an exploration of the topic at hand. First, one simply needs a general understanding of the issue. The next important component is to possess the ability to recognize and bring the right group of people to the discussion—a proper representation of those who are impacted by the issue and who can champion change. Then, begin with effective, thought-invoking questions, and always keep the conversation focused so that a viable solution can be reached.
After giving considerable thought to the challenge of improving hand hygiene compliance at UTMB, and after having many conversations with others, I have determined that we can do better. I would like each clinic, led by the nurse manager and medical director, and each inpatient unit or department, led by the nurse or technical manager and the medical director, to develop their own approach—an approach that will work best for each area. By working together with Healthcare Epidemiology, for example, the Surgical Intensive Care Unit improved their performance over a nine-month period from ranking as one of the lowest performers to achieving a 91% compliance rate (read more on this achievement on page three of the October 2015 issue of Friday Focus Newsletter).
I encourage all of you to work together at your clinic, unit or department level on this topic. Discuss your performance to date, and once you see where you are in terms of that performance, develop an approach that you believe will work best for your area. Then, track and communicate the results. Hand hygiene results can be viewed at an overall level on the Hand Hygiene website and by unit/department level at http://scorecards.utmb.edu. I will be asking each of the managers at our December Health System Leadership Team meeting to develop an improvement approach by January 15, 2016 and then begin to implement it. Our goal is that all units, departments and clinics achieve a 90% or better outcome for hand hygiene by August 31, 2016.
I am confident that each of you can help us to move to a higher level in this area. Hand hygiene is one of the most important ways infection and the spread of germs can be prevented and is an integral part of infection prevention practices. Our patients deserve our careful attention to this matter so that we can assure them of the safest possible patient care environment.
Thank you for all you do every single day to contribute to “simple solutions” for the challenges we face. I am grateful to you all for your dedication to assuring that our patients are cared for in the best possible way!