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TST's Web-based Solutions to Quality, Patient Safety Concerns

October 28, 2010
From AHA News October 18, 2010 By Charles Wisniowski The Joint Commission urges hospitals to take advantage of a new tool designed to help hospital staffers wash their hands of some of the most troublesome and preventable cleanliness compliance issues confronting health care providers today. After more than a year-and-a-half of testing and development, the Joint Commission Center for Transforming Healthcare, supported by the AHA, last month rolled out its web-based Targeted Solutions Tool (TST) for widespread use to any hospital or health care system that elects to participate. The first solution the Center has targeted for a TST full-court press is the issue of hand hygiene compliance. "The TST provides the foundation and framework of an improvement method that, if implemented well, will improve an organization's hand hygiene compliance and contribute substantially to its efforts to reduce the frequency of health-care associated infections," said Joint Commission President Mark Chassin, M.D. "This powerful application simplifies the process for solving these persistent quality and safety problems." The TST is an interactive, online tool to guide health care teams through a step-by-step process to measure an organization's actual performance, identify barriers to excellent performance and pinpoint proven and tested solutions. "Before the tool was available, what would have normally happened is that someone in administration would say 'We have a problem with hand hygiene. Go fix it,'" said Melody Dickerson of The Joint Commission's division of support operations. "That person would be charged with trying to collect data on their own and in the past, the focus would have been on a compliance number." But she said TST focuses on the causes for failure. At the start of the project in April 2009, the eight pilot hospital organizations that would create the solutions were surprised to learn their rate of hand hygiene compliance averaged 48%, she said. By last June, the organizations had reached an average rate of 82% that had been sustained for eight months. Among the most vital components of the TST is the tool's ability to collect data. By providing quantifiable results of its hand hygiene initiative, TST participant Exempla Lutheran Medical Center in Wheat Ridge, CO, secured and retained buy-in from its staff. "We've been able to show the staff that over the last 17 months of having our hand hygiene compliance rate over 90%, we have seen a significant decrease in our hospital-acquired infections," said Amber Miller, the hospital's infection prevention manager. "I've been able to share that information with staff and say yes this is making a difference in patient care and outcomes and that you are saving lives." TST takes the best parts of the Lean, Six Sigma and Robust Process Improvement ideologies and infuses them with the innovation and tested solutions developed by working hospital peers, said Robert MacDonnell, a Six Sigma Black Belt with TST participant St. Joseph Mercy Health System in Ann Arbor, MI. "It not only uses the proven approach of Six Sigma methodology, but it lays out all the steps in a practical way of how to go about getting better compliance and having a sustained result," he said. TST is available free of charge to Joint Commission-accredited organizations. The program tracks compliance data, graphs the results and targets problem areas in need of resolution. It then helps users implement solutions identified during the data collection phase and provides guidance to program leaders charged with helping staff change their behavior and comply with hand hygiene policy. "The implementation guides are designed to be a reference point," said Dickerson. "If you need to adapt your workflow process to make it work in your organization, that's exactly what you should do." The eight hospitals, working in collaboration with the Center for Transforming Healthcare, wanted to fashion a low-maintenance but high-tech and user friendly mechanism in the TST that would be an equalizer for smaller hospitals seeking to protect their patients from preventable infection. "There's a lot of excellent knowledge about the process and outcomes for solving these important patient safety issues embedded in this TST that has not been available to hospitals prior to this," said Beth Lanham, TST participant Froedtert Hospital's director of Lean Six Sigma in Milwaukee, WI. Dickerson said work has begun to incorporate the TST into other compliance problem areas with a wrong-site surgery pilot scheduled to kick off during the first quarter of 2011, followed by hand-off communications in the third quarter of 2011 and surgical site infections during 2012.