Did You Wash Your Hands? Lean Six Sigma Asks Tough Questions

In a hospital or healthcare facility, this question creates a great deal of concern across all levels of the organization. Research clearly shows that improvement of hand hygiene programs in hospitals reduces patient infection rates. History also shows that efforts to improve hand hygiene compliance have been difficult to implement and sustain. Barriers that inhibit the proper implementation of effective hand hygiene programs have readily been identified. With that said, studies that show how these barriers vary among hospitals are lacking.

Recently, a Lean Six Sigma program by The Joint Commission was implemented across a group of eight random hospitals in the US. The purpose was to assess the cause(s) of hand hygiene non-compliance and to drive improvement across the organizations. The program identified 24 different causes of non-compliance across the eight organizations. Each individual organization had elements of the 24 causes identified, but no one organization had all 24 causes in an individual facility. The first understanding gained during the process was that each individual hospital had implemented processes to correct hand hygiene compliance without properly understanding the underlying causes of the problem.

The result was that each individual organization had areas of performance improvement, but left a wide ranging of negative variances unaddressed. The Lean Six Sigma team understood that a one size fits all solution across the eight hospital groups would not be acceptable or achieve any desirable result. The hand hygiene compliance issue was addressed at each individual facility by the Lean Six Sigma team.

After a thorough exercise of the Lean Six Sigma process, the eight hospital groups reported a 70.5% improvement in hand hygiene compliance, which was sustained over an 11 month period. The process and related performance was a clear indicator for healthcare that a one size fits all” approach to resolving a problem that is perceived by many as an “easy” to fix problem is unacceptable.

The study also clearly shows that a Lean Six Sigma process is the most effective approach to resolving issues in healthcare organizations. These organizations can be very resistant to change. This resistance is typically based on the practice of healing as a science, and the practitioners demand extensive scientific data to address issues, even when change is required. These same practitioners also do not warmly embrace change, and feel that old methods are what is the comfortable method. Leadership of these organizations understand the importance of change, and are willing to change, but are not willing to battle with clinicians and practitioners to implement new processes. Organizations who are finding significant success in healthcare have embraced and accepted Lean Six Sigma programs, with leadership and practitioners being in agreement.