And, apparently, it works. For the eight leading hospitals, hand hygiene compliance averaged 48 percent in April 2009. But by June 2010, after the program started, it reached 82 percent, TJC says.

To learn more about the system and how well the results will apply to smaller hospitals, DOTmed News spoke with Melody F. Dickerson, a certified Six Sigma "Black Belt" with the Joint Commission's Center for Transforming Healthcare. Prior to joining the center, Dickerson helped implement the center's hand hygiene project at Wake Forest University Baptist Medical Center.


DOTmed News: Why did The Joint Commission choose hand hygiene compliance as the first solution?

Melody Dickerson: We actually selected the eight hospitals first. They were selected because they all have the common thread of robust process improvement, specifically a lean Six Sigma program in their organization.

So once we selected the eight hospitals the question was posed to them: what was the number-one patient safety challenge? Notice I didn't say your hardest Joint Commission standard. They actually responded that hand hygiene was the biggest challenge. That is probably the result of the standard at the time, which said you had to show you had hygiene compliance of 90 percent or higher. That standard was actually changed as the result of this project, because once we collected our baseline measurements, it became painfully clear that 90 percent was a bit of a lofty goal...And some of the places that were actually demonstrating it were creative with how they were collecting their data.

DN: The tool gives hospitals charts - how does this help hospitals track their hand-washing compliance?

MD: They get three kinds of charts. First, a proportion control chart, which are compliance rates over time. They can filter it by day of the week, day-shifts compared to night-shifts and also a filter for entry versus exit.

The second chart is a Pareto chart: the Pareto chart is looking at the more common contributing factors, ranking from most common to least common. That's what drives targeted solutions. You'll get the solutions in those ranked orders.

The third chart is an analysis of means, and the analysis of means chart compares different health care worker types and looks at variation among groups and looks at number of data points that you have. And it really is a good way comparing groups, to say, for instance, that you know housekeeping is statistically significantly more likely to have a hand hygiene defect - not washing their hands - than other groups. It can also tell you if one group is statistically significantly better than other groups.

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