9.26.2008

Acting Like Big Brother Won’t Help Hospitals

Hospital infection rates are higher than they should be because many hospital workers don’t wash their hands as often as they should. That is well-established, and many hospitals involved in improvement efforts are focusing on improving the rate of hand-washing.

More than a year ago, I
discussed the issue of just how you get people to wash more often. I cited a blog post by Mark Graban, which included suggestions by author David Mann. Mann made the point that processes can be set up to change behavior, with approaches that include better education of employees, visual controls to instruct people and a process for allowing people to anonymously report offenders.

But not everyone understands that. I was disturbed by a recent
posting on The Wall Street Journal Health Blog about a company called Arrowsight. The firm is marketing a service to hospitals specifically designed to improve hand-washing rates, which it says “has worked in food processing and manufacturing plants.” The service: video surveillance.

In an earlier pilot, launched in January of 2007, the company says its hospital video auditing service boosted hand-hygiene compliance to 90% from 38% in three months. The improvement was durable, remaining above 90% for twelve months running…

While live auditors won’t be monitoring worker’s every move 24/7, the Arrowsight system is programmed to search huge volumes of video very efficiently. It’s smart enough to catch such triggers as a door opening to a hospital room to capture whether staffers washes their hands after entering.

If the compliance rate remained high for 12 months, that is only because employees know they are still being watched.

More importantly, video monitoring flies in the face of the lean principle of respect for people. It can only make workers suspicious and resentful, and hurt morale. And it certainly does not encourage anyone to be a creative, thinking employee who contributes improvement ideas.

I hope hospitals will resist this approach.

3 comments:

Mark Graban said...

I'm a bit torn on this Ralph. I agree it reeks of Big Brother, however... does it show "respect for people" to not follow proper hand hygiene practices? This leads to infections and patient harm. The hospital industry has been unable to address this problem.... I think a video surveillance system *could* potentially be done in a "respect for people" way if 1) management is upfront about its use, 2) management reiterates why this is so critical and 3) management also creates an expectation that root causes of not washing hands will also be addressed.

I did a "5 whys" exercise with a hospital team once -- why are people not able to wash their hands 100% of the time? You find actionable problems like carts not always being available or easy to find, therefore employees hands/arms are full and they don't stop to wash. You can address things like that... but if the "standardized work" says to wash before and after leaving each patient room, then it's fair to assume that will be monitored, that the standardized work is audited.

Maybe I'm wrong, but I think the video might be a necessary step. Why not extend that to operating rooms to make sure the required "time out" takes place???

I don't think video is a cure all, but I don't think it should be ruled out altogether.

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