Five lessons for managers from the frontlines of hospital hand hygiene
Authored by: Dr. Marco Bo Hansen, Nancy Carleton, and Anastasia V. Linn
We all want to know how best to cope with this pandemic. How to keep ourselves healthy. How to support our teams and communities. How to continue fostering organizational success.
As a company specializing in improving hand hygiene through data-driven solutions, we have a unique perspective on what’s happening on the ground, particularly in hospitals and nursing homes. Working with and within healthcare institutions during this pandemic, we have learned a lot about what works and what doesn’t when it comes to infection prevention and realizing behavior change. While our research focuses specifically on hand hygiene improvement, our findings can inform the broader management community, especially now.
So how can managers keep their teams safe, communities healthy, and productivity high while laying the groundwork to prevent the next global pandemic? Based on our experiences working with high-performing hospital management and staff, we have five insights to share.
1. Prepare for the next global pandemic.
Given current epidemiological expectations, the influence of climate change on pandemic likelihood, and the on-going threat of multi-resistant bacteria, infection prevention will remain important even after the challenges of Coronavirus become less acute. The World Health Organization forecasts that by 2050 more people will be dying from multi-resistant bacteria than from cancer and traffic accidents combined. Those numbers can be decreased by implementing good hygiene practices. In organizational contexts, this requires managers to no longer take workplace hygiene and organizational health for granted.
Since the COVID-19 pandemic outbreak, we have all learned to take additional precautions to avoid infecting others. We sanitize our hands when entering buildings, avoid interpersonal contact, and practice safe distancing. However, the resounding question remains, “When will things return to normal?”
The problem with such thinking is that “normal” is what got us here in the first place. Implementing effective health and safety strategies and preparing for future risks requires accepting the unpopular notion that our hygiene behavior has taken a step forward during this pandemic. Our standards of cleanliness and safety have changed. Returning to less hygienic habits would not be a responsible, or economical choice, regardless of whether an immediate viral threat like COVID-19 was present or not. To protect their workforces and ensure their companies’ long-term viability, managers must start to think more strategically about long-term organizational health.
The current pandemic has brought organizational health and hygiene from a non-issue to the top of the agenda. Many business leaders and organizations have already begun to address this by investing more in organizational health, safety, preparedness, and expanded workplace sick leave policies. Additionally, in a survey of Fortune 500 CEOs, 63% reported that “despite financial pressures,” the COVID-19 crisis would accelerate their investment in technological advancements, many of which have directly influenced employee health and safety.
While it might not be the sexiest topic, workplace health and hygiene can no longer be ignored. Those who choose to invest in long-term solutions now will be poised to benefit in the long run.
2. Prioritize community health over patchwork firefighting.
In making health and safety strategy decisions, managers must remember how their choices affect the wider world. This pandemic has made us much more tangibly aware of our interconnections and the fact that every organization exists as a part of innumerable larger systems. Just as distributing influenza vaccines improves herd immunity and helps protect the most vulnerable individuals from infection, every organization’s choices have an effect on infection risk on a much broader scale than may be immediately obvious.
As such, organizational health decisions are not just about protecting your workforce, the welfare of the organization, or even the health of your clientele, but also the livelihoods of all those with whom those individuals have connections. Namely, the global community in which your organization is embedded.
This premise is likewise true in our work with hospitals. When hospital staff improve their hand hygiene, they aren’t just protecting themselves or the patients for whom they care, but also their colleagues, their communities, and the loved ones of all involved.
This fact has become even more evident in the face of Coronavirus. The COVIDtrace project we are conducting in collaboration with the Technical University of Denmark (DTU) and the support of the Danish government specifically addresses this reality. The project focuses on improving hand hygiene compliance and automating contact tracing in hospitals and nursing homes to quickly identify exposed individuals and initiate appropriate preventive measures, such as testing for COVID-19 or quarantine. By using Sani nudge technology in concert with algorithmic analysis developed by AI researchers at the DTU, we can track hand sanitization habits, map infection risk, and implement rapid containment measures should an infection break out. When labor-intensive manual methods of contact tracing allow more time for those who have contracted the virus to infect other people—especially those in high-risk condition—improving response speed like this is critical in stopping the spread of the disease, both within hospitals and beyond. With exponentially more data being amassed over time, we might be able to predict where infections will occur in our organizations before they actually do and thus set up targeted prevention measures.
How leaders respond to crises like the Coronavirus pandemic also impacts an organization’s relationship with their communities in a more commercial sense. While some companies have earned brand loyalty and inspired others with their swift, caring, and resolute responses, others have disappointed their stakeholders and lost brand value by reacting in ways audiences found inappropriate. Such moves are not easily forgotten. An international survey of 12,000 respondents conducted by Edelman in March revealed that one in three respondents had already convinced others to stop using a brand that they felt wasn’t responding appropriately to the pandemic. These decisions also impact an organization’s reputation as an employer. Given current conditions and future predictions, organizational hygiene policy may establish itself as a new, highly important determining factor for employees and job seekers. In light of all this, prioritizing health and safety is an investment that managers cannot afford to avoid.
3. Use the tools you have available. Technology and nudging can help.
Fortunately, today’s managers have a wide array of tools and solutions available to them to effectively implement new hygiene standards and other forms of behavioral change.
Even solutions that appear technically simple yield impressive results. We have found, for instance, that just by using lights and discrete symbols on existing hand sanitation facilities, a Danish surgical team increased hand hygiene compliance by 25%. These results are consistent with the increases observed at the “nudging” stage in the hospitals where we have worked.
Many of us have experienced this effect ourselves in non-hospital contexts. For instance, while many shopping centers and supermarkets require hand sanitization at certain touchpoints, the prominent presence of alcohol dispensers serves as a visual nudge reminding shoppers to sanitize their hands, even more often than is mandated by the stores. As repetition is essential for habit formation, visual reminders such as objects, lights, notifications, and signage significantly impact behavioral changes. This knowledge offers various opportunities for managers looking to support their organizations in the adoption of new habits. Likewise, being conscious of which messages are being repeated—intentionally or not—is invaluable for more effective change management.
How do your organization’s facilities support—or hinder—the choices you want to encourage? What behavioral norms are present, and which should be changed or added? Do all team members know that their feedback on a particular issue is valued? Most organizations believe that “where there’s a will, there’s a way,” but motivation alone cannot drive behavioral change. In the case of hand hygiene, leaders can design their organizations to make hygienic practices the easy choice. They can foster a workplace culture that makes it psychologically safe and acceptable to remind others to perform hand hygiene and encourage colleagues to go home from work if they show signs of illness. Unspoken norms can be recognized and altered. You are not seen as a more valuable employee if you can work while you are sick, for instance. You risk infecting others.
While high-tech, high-investment solutions remain an option, managers can also support their teams in using technologies they already have access to in novel ways, including COVID response and infection prevention. For instance, the COVIDtrace project puts existing technological infrastructure to new use by adding additional sensors near patient beds to track caregiver-patient interactions along with hand hygiene habits. What resources do you already have available? What forms of communication can be leveraged anew? As a manager, how can you implement changes in your own behavior to support those you wish to see throughout the organization? Challenging times inspire remarkable ingenuity. Learning to look for and support this kind of innovative solution-finding is invaluable for organizations, no matter the external circumstances.
4. Keep track of progress.
Management wisdom has long held that “what gets measured gets managed.” While easily quantifiable factors are not the only ones that matter, technological developments offer managers new opportunities to measure and affect behavioral change.
In our research with hospitals, we have clearly seen the impact of data accessibility on hygiene improvement. While sparking team spirit by sharing anonymized team data can serve as a lever for improving hand hygiene performance, we have found in multiple studies that providing team members with individual feedback has the most positive effect on improvement. In a study of doctors and nurses in an orthopedic surgery department, receiving personalized feedback improved the health care workers’ hand hygiene by 25% versus teams that received anonymous group feedback. This was associated with a decrease in bacterial infections and sick leave taken by the staff.
While personal data collection raises valid privacy concerns and doesn’t necessarily apply to all areas of work and workplace safety, the relevance of personal feedback does. How have colleagues been affected by recent or proposed changes? What changes have been easy for them, and what can be done to improve their adoption of new practices that have been less easy to implement? Managers at all levels of the hierarchy can improve the likelihood of behavioral changes by inviting respectful, engaged dialogue. The value of psychological safety in such situations cannot be overstated.
Combined with knowledge of the larger implications of individual actions—the demonstrable impact of individual hand hygiene on infection prevention in hospitals, for instance—such dialogue can have a huge impact on the effectiveness of organizational change initiatives. Because in the end, organizational change is individual change at scale.
5. Don’t settle for “good enough.” Set new standards.
The hospitals we work with already prioritize quality hygiene practices before implementing our automated hand hygiene measurement system. However, by collecting precise and granular data, even extremely high-performing hospitals improved their results. In a year-long study at a Danish university hospital, it became evident that while hand hygiene compliance in patient rooms was high, it was often overlooked in areas like the storage room where reminders of infection risk are less immediate. By working with employee behavior in a targeted, informed way, the hospital tripled its hand hygiene performance in certain areas. When faced with the kind of risks posed by Coronavirus, improvements like these can make all the difference.
As with sustainability initiatives where the goal has moved beyond becoming carbon neutral towards becoming carbon negative in order to give back, many organizations now realize the value they can create by surpassing existing standards and championing employee health in their organizations.
Hospitals have long established themselves as benchmarks for the highest standards of hygiene and workplace sanitation. Given the legal requirements and decision-making processes within the healthcare industry, however, progress can be slow, and innovations can take years to implement. Many business leaders have the opportunity (and therefore, the responsibility) to move quicker on these issues. In doing so they can help set new standards for the communities, industries, and policies around them and gain a competitive advantage.
Fostering resilience in times of disruption
By the time this article is published, the pandemic conditions will already have evolved. While we can hope that the situation will improve, the rapid nature of these developments only serves to underline the importance of learning how to support on-going behavior change. Simply waiting for external conditions to stabilize would be a wasted opportunity.
This pandemic is taxing and, at times, devastating, but it also offers profound opportunities for transformation to the leaders, individuals, and organizations who are willing to take them. Rather than hoping for a “return to normal,” we can see this period of immense challenge as an opportunity for practicing the sort of nimble adaptation that will become only more valuable in the future.
Whether improving hand hygiene and investing in workplace safety or adopting appropriate technologies and learning to support behavioral change effectively, the developments required by the current situation are less important than the resilience built by implementing them. Learning how to sanitize one’s hands is not as important as learning how to establish new habits. Learning how to use a certain new technology is not as beneficial as becoming more comfortable confronting the unfamiliar. Realizing the changes themselves may be critical, but it is not nearly as valuable in the long-term as building trust in your ability to evolve. This is the frame that managers can take with them into their organizations.
Those who become adept at adapting in these ways—quickly, thoroughly, and with purpose—will be poised to succeed, not only for the duration of the Coronavirus outbreak but far into the future.