A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

Abstract

Background: Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers' compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers' views on current and innovative strategies to improve hand hygiene compliance. Methods: Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. Results: Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. Conclusions: To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers

“…Kebede et al stated that the establishment of hospital manager training in order to better equip them with management skills may promote scalable improvements in health facility functioning ( 14 ). As senior health care managers play an important role in the design and operationalization of quality improvement programs, they can offer a unique perspective on how to improve areas of practice with which healthcare organizations are often struggling to improve ( 21 ). This study showed that people skills were important for hospital managers.…”

“…Lack of transparency rules and duties and role of managers also were expressed as challenges for hospital management. McInnes et al found that culture change starts with leaders and is one of the main issues that managers have faced in hospitals ( 21 ). Therefore, it is suggested that high-level meetings should be scheduled between the Ministry of Health and university heads at early stages in order to gain leadership support in deploying change.…”

How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections

“…Hospitals need to come up with innovative ways of monitoring HCWs’ HH performance and provide them with proper feedback. McInnes et al conducted a qualitative study that aimed at understanding the perspectives of senior managers regarding current and future strategies to improve HH compliance [ 9 ]. Alongside several interesting issues mentioned, the need of having individualized and immediate real-time feedback of HH practices must be highlighted.…”

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“…204 – 206 A study investigating the failure of an HCAIs strategy found low levels of physician engagement and compliance with guidelines and policies. 207 , 208 Even in healthcare facilities where policies, guidelines, and checklists were effectively implemented, doctors and other health professionals’ practices were found to degrade after around one year. The reasons given included: too much information being provided; guidelines being too complicated to implement; that guidelines conflicted with other guidelines, and because little evidence was provided to support the guidance.…”