Culture eats strategy for breakfast

Over a decade ago I was lucky enough to work at the Henry Ford Health System in Detroit, which is recognised as one of the leading health systems in the United States.  On my last day I accompanied the Professor of Surgery to ICU, and as he was about to touch a patient the Health Care Assistant (HCA) spoke up and said “please don’t touch that patient”.  When the Professor asked why, the HCA said it was because he hadn’t washed his hands.  With a discerning nod, the Professor thanked her for reminding him.   This gave me a glimpse into the culture of an organisation where people felt empowered to speak up if they saw something that was wrong. 

Ward 33N celebrates good hand hygieneWe have a great example of this in action in Ward 33N, at Middlemore Hospital where staff have challenged the unacceptable and gone from a 50% hand hygiene compliance audit in 2012 to a remarkable 94.4% – the highest in the hospital.

To put this into perspective all District Health Boards around the country sit at about 75% – 80% hand hygiene compliance. At CM Health we sit at 76%. While this is higher than the national standard of 70% Counties Manukau Health aims to achieve 80% by June 2015.   The question is if we can achieve 94.4% on one ward i.e. Ward 33N, how can we replicate this across the organisation?

So what is Ward 33N doing to consistently achieve such great results? Well the first thing is no-one likes to be told they have the lowest hand hygiene compliance in the hospital, so the motivation to improve was very strong. There was also a strong sense of ownership and determination by all of the staff to make the changes required.

This included reminding others to wash their hands before and after contact with patients, and procedures, and challenging health professionals who failed to comply. Like the HCA I mentioned earlier on, speaking out takes courage and I commend the staff on Ward 33N for asking the questions that everyone should be asking.  Patients and visitors are encouraged to ask staff if they have washed their hands prior to any contact and a monthly competition between doctors, nurses and other health professionals, as to who has the best hand hygiene is proving popular.

As a result Ward 33N has seen a culture shift. Good hand hygiene is now the norm and anything else is clearly unacceptable.

If you would like to find out more, contact the ward hand hygiene resource nurse Brijesh Singh (extension 7442) or Charge Nurse Manager Janene Lawrence (extension 6250).


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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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