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cent of first doses within an hour, and 86 percent stopped within 24 hours, which is the other component of the measurement. Then you have to pick the right antibiotic: It must be appropriate for the procedure, and there are clear guidelines on that. In 2007 across all of the different groups of procedures, from vascular to gynecology to orthopedic surgery and colon surgery, 95 percent had selected the right antibiotics,” says Chassin. The Joint Commission has taken a leadership role among all of the leading organizations in infection prevention and control, including the Infectious Disease Society of America, the Society of Hospital Epidemiologists and the National Foundation for Infectious Diseases, whom it catalyzed to undertake a comprehensive review in 2008, looking at critical infection issues in hospitals. The result of this review was the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, which principally focuses on getting hospitals to make their programs working more effectively. The Commission also produces other resources to educate its members, such as educational conferences and consulting, as well as publishing various booklets and brochures.
Clean hands Designated by the World Health Organization in 2005, The Joint Commission is the only world collaborating center for patient safety solutions. The WHO’s initiation of this global patient safety initiative took hand hygiene as its first challenge, which has been a National Patient Safety goal of the commission for some time. The continued prevalence of healthcare-associated infections and their prominence in the healthcare debate has prompted the commission to step up its operations, so for the first time it is preparing to engage with healthcare organizations Mark Chassin to create interventions to improve safety and quality. “We’ve created requirements for organizations to improve their processes and outcomes, but in the past we haven’t engaged directly with them in solving some of these critical problems,” explains Chassin. “That’s what this new activity is focused on. We are launching a component of The Joint Commission called the Center for Transforming Healthcare; it is a separate component, like the Joint Commission Resources, but a subsidiary. “We’re not for profit, so our focus is to use some of the newer tools of process improvement, such as Lean Six Sigma and change acceleration, to begin working with a group of 16 leading hospitals and health systems that have themselves already made the investment in mastering these tools. We can use this systematic approach to solving problems to attack these critical quality and safety problems that every organization has been struggling with. “The first topic the participating hospitals chose for this effort, which was launched earlier this year, is hand hygiene failures. We’re talking about some of the leading hospital systems in the United States, from Hopkins and Mayo
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to Inner Mountain in Utah, Partners in Boston, New York Presbyterian in North Shore in New York, Cedars, Stanford, Kaiser in California, Exemplar in Colorado, Memorial Herman in Texas. It’s a very impressive list. They identified a number of their highest priority problems, and hand hygiene failures got the most number one, high priority votes. “For about 15 months, The Joint Commission has been undertaking a very aggressive program for our own internal process improvement of adopting strategies and methods, the same tools of Lean Six Sigma and change acceleration. We have our own Lean Six Sigma experts whom we are bringing to this new center’s activities to work with these organizations. The hallmark of what’s different about this approach is the systematic methodology to solve these problems, which starts with an agreement on reliable and accurate measurement systems and hand hygiene. “There currently aren’t any good, easy to apply, systematic measurement systems to know what your performance is, and if you can’t measure something reliably, you can’t improve it effectively. The second issue is, once you’ve got a good measurement approach, to understand these tools with systematic applications and figure out why the process isn’t working. That’s a step in the Lean Six Sigma approach to solving problems that is absolutely essential in these critical quality and safety areas, where solutions have remained elusive. This leads you to be very precise about what the causes of the failures are in where you’re trying to fix the problem,” he explains.
Finding the cause Chassin hopes this approach will pinpoint the major reason why hand hygiene compliance is so hard to achieve, and why the distribution of the causes of noncompliance differs from one place to another. He provides an example of solving the problem of soap dispensers and their location outside patient rooms, noting one surprising major cause of infection in a large number of hospitals is the number of healthcare staff approaching patient rooms with unclean hands. Unless the process is carefully assessed and the reasons for failure understood, it is impossible to target interventions that effectively manage the high impact causes, nor can improvements be made. Chassin believes this is the key activity that differentiates the center from others pursuing this methodology. The second difference is that this methodology is now married with the reach of The Joint Commission. “Our job is to coordinate these projects, oversee them and make sure they’re done exactly the same way with fidelity to this method so that we can compile results across all of these organizations,” he explains. “Eight of the 16 are participating in this first project of hand hygiene, and the remaining eight are just starting the second project. “Every hospital is worried about hand hygiene. Our job is to put the learnings from these initial projects into a knowledge database that we can