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Sanja Mirkov, BPharm, PGDipPH Clinical Quality Improvement Coordinator

Sanja Mirkov, BPharm, PGDipPH Clinical Quality Improvement Coordinator. Improvement Science Professional Development Program The Hand Hygiene Project. The Hand Hygiene Project Content and Aim. Aim Establish reliable HH practices within CMH healthcare facilities

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Sanja Mirkov, BPharm, PGDipPH Clinical Quality Improvement Coordinator

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  1. Sanja Mirkov, BPharm, PGDipPHClinical Quality Improvement Coordinator Improvement Science Professional Development Program The Hand Hygiene Project

  2. The Hand Hygiene Project Content and Aim • Aim • Establish reliable HH practices within CMH healthcare facilities • To increase correct HH practice rate from 60 to 80% by 30th June 2013 • System • Stable in state of statistical control - improvement can be achieved only through a fundamental change • Guidance • Methods for developing fundamental change: • Benchmarking or learning from others – e.g. literature search • Creative thinking – provoking new ideas for change - Using change concepts • Logical thinking about the current system – e.g. workflow checklist, comparison of measurements in the Gold Audit • Constraints • 1.Common ineffective approaches to improvement applied previously: • Trouble with performance – add more inspection • 2. Negatively framed promotional activities in the past • 3. Financial constraints for using technology

  3. Strategy • A literature review identified successful interventions to inform CMH multimodalstrategy with an emphasis on behavioural change • Strengthen the team (complementary skills, equal commitment, accountability, trust, respect and support) • Increase staff capability (education, training, dissemination of information) and motivation (social marketing, persuasion, modelling) • Create physical (facilities, workflow, reminders, institutional safety climate) and social environment (human networks as channels for communication and behavioural change, engagement, community organising) that influence staff capability and motivation • Identify potential quality improvement projects • Perform PDSAs • Implement successful quality improvement projects

  4. The behaviour change wheel Capability, Opportunity, Motivation Mitchie et al Implementation Science 2011;6:42 Social Networks Christakis et al. PLoS ONE 5(9) Diffusion of innovation curve Rogers Strategy

  5. Hand Hygiene Primary Drivers Education, Training & Promotion Facilities, Workflow and Reminders Monitoring and Reporting Organisational Culture Change

  6. Driver Diagram

  7. Measures

  8. Change Concepts & Ideas for PDSAs Opportunity

  9. Change Concepts & Ideas for PDSAs Capability & Motivation

  10. Results of your PDSAs

  11. Profound Knowledge Worksheet

  12. Process Changes and Results • Positive, consistent messaging • Engagement at a ward/unit/occupational group level • Identification and engagement of “activists-in-place” • Endogenous generation of improvement activities • Ongoing communication and feedback, education and training, persuasion, role modelling • Provision of supportive physical and social environments • Acknowledgement of staff initiatives

  13. Ward A October 40.7% March 73% Ward B October 38.5% March 58.6% Ward C October 58% March   58.2%             March Gold Audit Interim Report

  14. Next Steps • Developing additional resources • Broadening the base of our champions and members of the HHWG • Beginning the top-down phase of our social marketing campaign • Considering improving measurement

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