Create a Culture of Safety

Hospital “Partnership with your staff”:

Proving Effectiveness of Hand Awareness by creating a “Partnership with your staff” to improve “culture of communication” and Reduce HAIs:

In the hospital setting there will be multiple benefits:

  1. Jump start the culture of safety movement,
  2. Reduce HAIs,
  3. Reduce colonization of HCWs nares,
  4. Reduce C.difficile events in hospital setting,
  5. Reduce staff absenteeism due to illness
  6. Corrective Action plan for hand hygiene non compliance


It is past time that the tenets of Patient Safety are practiced in health care institutions. Unfortunately physicians are at the center of the implementation being more of a barrier than facilitator. As they are handpicked as individualists, then groomed and trained to be decisive, not dependent or indecisive. Effective Patient Safety is collaborative and patient centered. In order to change such ingrained behaviors it is necessary to use strategies that effect both the emotional and cognitive centers of the brain to break down unwanted behaviors. I am looking for an institution(s) who are interested in helping to achieve a higher benchmark for patient Safety to demonstrate to other institutions in this country and the world that it can be done. It requires an institution that has the corporate goal to achieve best practices and at the same time have the ability to admit vulnerability in known Patient Safety practices and the gumption to improve present practices. The result will be to be a part of the greatest impact in Patient Safety since Ignaz Semmelweis MD and Oliver Wendell Holmes MD.

This Hand Awareness Partnership combines the many successful strategies for behavior change: Positive Deviance, social marketing, humor, animation, self efficacy, Hawthorne Effect, increased accountability, repetition and diffusion of Innovation. It has been designed to look like a children’s program to avoid the natural defense of the adult “know it all” syndrome. It provides new knowledge to many HCWs and self efficacy for them that they can make a difference in a patient’s outcome. There are two basic types of styles of medical service that exist in hospitals today: the corporate model(training hospitals and employed models) where employees can instructed to follow dictums or result in loss of job or the cooperative model of mutual benefit (community hospitals). The training facilities and ICUs are more receptive to the CREW resource management type of intervention than the community hospital that relies on independent practitioners and require a more empowerment model to make progress in taking steps toward a culture of safety. As you delve deeper into the attributes of the Hand Awareness Partnership to your institution you will discover even more benefits to your organization’s operation.

Improving the “culture of communication” by breaking down communication barriers, both artificial and imposed, between all levels of HCWs by implementing the Hand Awareness Partnership in your hospital. It emphasizes communication as a priority of the administration and medical staff to encourage everyone in the hospital setting, patients and family members included, to participate. It provides a platform for everyone (both HCWs and non HCWs) in the hospital to comment to peers, non peers and visitors about one’s hand hygiene behavior, free from worry of an adverse reaction. Since it is a behavior that is carried out virtually 100 to 300 times per shift, it provides ample time for even the most insecure HCW to practice their delivery of a corrective action or dissenting statement to non peers. Repetition is required to perfect one’s delivery of any such statement that runs the risk of offending someone’s rank or personal integrity. After practicing “genuine” communication with non-peers and peers, everyone is in a more comfortable environment to express opinions around more serious issues (medications, treatments, diagnostics, etc.) that could have a substantial impact on patient outcomes.

Jump start the culture of safety in the hospital institution by improving “genuine” communication between non-peers and peers. There is a growing communication gap between physician peers, as well, because HCWs are too busy. There is less “collaborative” communication and decision making around patient care in many institutional environments that are outside the training hospitals, verbal and those written in the progress notes. There is an emphasis on documentation in the charts for billing and legal purposes, but not true critical thinking communication documentation. Also, there is less face to face communication from physician to physician and physician to nurse about the patient care. Yes some have collaborative rounds in training programs, but not in most of the community hospitals. To improve the culture of safety it is necessary to empower everyone who comes into contact with the patient to believe they have an impact and voice in the patient’s care. One must be in their comfort zone to be truly effective.

Reduce HAIs by increasing accountability for the expected behavior in the hospital setting to be closer to 100% compliance. If more observers (known and unknown) are around (unit clerks, transporters, patients, nurses, physicians, administrators, patients and family members, etc.) watching and commenting on the Hand Awareness(hand hygiene, respiratory etiquette and cross contamination awareness) compliance will improve. Promoting an open and continuous surveillance of hand hygiene compliance will achieve better results than intermittent monitoring.

What is your observed rate of handwashing?

Who are doing observations?

Where are the areas you believe need improvement in Hand hygiene?

Reduce colonization of nares by MRSA and other organisms by learning not to put a finger in your eyes, nose or mouth (T zone). We do annual surveillance on TB, but not MRSA colonization, which has been proven to end up in surgical wounds and affects patients morbidity and mortality, as well. There is only one way that the nares become colonized. So if a HCW not does not have enough self preservation or awareness about their own health, how can they be so diligent about others?

Reduce C.difficile events in hospital setting by improving accountability of Hand Awareness and active knowledge about when to wash with soap and water versus sanitizer. By increasing awareness and knowledge about what types of infectious diseases are on the ward, listing in the nursing stations, there will be greater compliance with the appropriate hand hygiene action (handwashing versus sanitizing). HCWs will be able to assist others in their compliance due to the cultural emphasis on both Hand Awareness and improved communication. When you ask all HCWs you may be surprised who believe sanitizer kills C.difficile spores.

Has your facility experienced increased C.difficile incidence and severity of complications?

What strategies are you considering for C.difficile incidence reduction?

New technologies to id C.difficile earlier?

Reduce absenteeism due to illness by reducing individuals contaminating their T Zone, the only portal of entry for ALL respiratory and gastro-intestinal diseases. They in turn teach their families how to protect themselves, who will end up having fewer infectious diseases, as well. A healthy employee is more productive. And there will be less concern on staffing issues in the winter months.


Hospital Kit

Letter to staff.

Infectious disease surveys 0, 2 and 8 Weeks to determine readiness

Dry erase boards in nurses station.

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