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Quality Improvement Project Work

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Introduction

This report aims to propose a change on improvement in handwashing compliance among healthcare professionals through patient empowerment, to reduce health acquired infections (HAI) in a hospital ward. Change that leads to quality improvement in healthcare sectors is constantly happening, it is a crucial aspect in healthcare practice, and it is highly required. (Al-Abri, 2017). Change is defined by The Health Foundation THF, (2013) as a systematic approach that utilises certain techniques that aim to improve the quality of care making healthcare, patient-centered, safe, efficient, timely, effective, and equitable.

Justification for The Proposed Change

There is a wealth of evidence available which shows that HIA endemic can be prevented through effective hand hygiene among healthcare professionals

(Allergranzi et al. 2014).  HAI’s are a risk to patients, visitors and, healthcare staff, and, to those infected causes significant morbidity and to the National Health Service (NHS) significant cost (NICE, 2016). HAI’s major route of transmission is through health professional hands and prevention and control of HAI is a major key priority to patient safety (Vincent and Coulter, 2012). The author chose this change after a patient was infected by HAI in the ward. The author also observed healthcare workers’ handwashing compliance which was very poor despite having a patient with HAI in the ward. Compliance with hand hygiene with optimal practice remains very low in most healthcare settings (Allegranzi and Pittet, 2017).

Monistrol et al, (2014) in their study done in a hospital with a high rate of HAI, concluded that the adaptation of frequent handwashing compliance will significantly decrease HAI incidence in hospitals. They further mention that decontamination of hands has been singled out as the most crucial way of preventing cross-contamination (Monistrol et al. 2014). World Health Organisation (2021) states that hand hygiene among healthcare professionals is an infection and control measure that is effective, simple, and low-cost.  McGuckin et al (2016) concluded that patient empowerment is a necessary component of hand hygiene compliance among healthcare professionals.

To implement this change, a proper change framework to guide the change process is required (Hossan et al. 2018). Lewin’s change model will be utilised and the Plan

Do Study Act (PDSA) framework for quality improvement will be applied, and this framework is widely used in NHS hospitals (Donnelly and Kirk, 2015). The rest of the report will look at the background information of HAI, barriers to implementation and leadership style will be discussed and finally, the evaluation strategy of the change will be explained.

Background

HAI is an infection that is acquired from the hospital or any other healthcare facility that occurs while receiving care (NICE, 2016). It develops  due to cross-contamination mainly through healthcare staff hands,  and  healthcare interventions (NICE, 2016).

In England, statistics show that 1 in 30 patients are affected with HAI daily and 300 000 yearly. This means additional use of resources for National Health Services which is already financially constrained (NICE, 2014).  The highest mode of transmission is through healthcare professional hands, and change is needed to reduce HAI morbidity (Haque et al. 2018). Globally strategies as patient involvement in supporting their safety has been utilised, and approach as patient participation and patient partnership has been used to combat HIA (WHO, 2019) Educating health professionals regarding hand hygiene, an alcohol-based hand rub approach has been also used, however, despite this the HAI rate remains high and of concern (Jones et al. 2017

The NHS standard infection control precautions: national hand hygiene and personal protective equipment policy emphasises the healthcare professional responsibility not to provide care while at risk of transmitting infectious agents to patients and other staff members (NHS, 2019). Hand hygiene is considered the most important practice in reducing the transmission of infection that causes HAI. The policy states that proper hand decontamination should be practiced, and proper protective equipment should be always used to prevent hospital-acquired infections (NHS, 2019).

The proposed change will involve co-production with patients, and everyone involved in patient care (Yau, 2015). Co-production according to NHS, (2017) is the contribution to the provision of health by patients and involves consulting and including service users from the beginning of a change project that affects them. Involving service users is the most crucial component of the multimodal strategy to improve hand hygiene adherence among healthcare professionals (McGuckin et al, 2018). Service users’ role  will lead to an increase in handwash compliance among the staff (Gaines, 2016). The proposed change  will utilise, patient hand hygiene leaflet tool and healthcare badges written ‘You can ask if l have washed my hands’.

 

Change Framework

Altering, transforming, or improving a system or way things are done in healthcare is a change that needs to happen to improve health outcomes (Cameron and Green, 2015). Implementing change is difficult, however, applying an appropriate change model should be paramount (Yau, 2015).  The model will guide the process, help to aid the transition, and help employees to accept and understand the benefit of the change (Deenitchin et al. 2015). Lewin’s model is defined as the fundamental change model that explains forces that strive to maintain the status quo and forcing for change (Lewin, 1974).  The model encompasses 3 distinct stages unfreezing, moving, and refreezing. The model identifies factors that can impede change from being implemented and strengthens the positive driving forces (Bozak, 2013). The author chose this model due to its beneficial simplicity; it accounts for both the resistance and uncertainty to change that all staff in an organisation can experience (Hossan et al, 2018). It is appropriate for this proposed change because it works best in a working environment that is sequential and repetitive and change is from the top down.

Whereas Kotter’s model has a bottom-up approach and is suitable for an environment that is changing frequently (Kotter, 1995). It is a step-by-step model, and its eightstage approach is complex, and requires more resources, and is suitable for a larger scale organisational change. Skipping one stage will lead to serious disruption to the process (Kotter, 1995).

 

Unfreezing Stage

This first step involves preparing the organisation that the change is necessary. However, to instigate a behaviour that is open to change there is a need to agitate the equilibrium state (Lewin, 1974). This stage involves unfreezing the status quo and communication is a key component of this stage (Lewin, 1974). Communicating openly, honestly, and effectively will build a sense of security, trust and reduce uncertainty among workers (Spears, 2016). Healthcare staff and patients will be communicated through round table meetings, discussing the reason for the change. These round table meetings will identify the fears and, resistance within the managers, patients, and staff. In the round table meetings, a convincing argument will be developed as to why the change is needed, and empirical evidence of HAI in the ward, morbidity statistics, mode of transmission, resources spent in treating those affected in the ward and the hospital at large will be provided. This stage involves challenging old cultures also, and this may revoke resistance in the individual that may impact the process of change negatively (Pittet et al. 2017).

During the round table discussion meetings, several evidence-based literature of a similar change that was implemented involving patients and brought a significant decrease in HAI will also be used during the meeting. Lastinger et al, (2017) conducted a study in a hospital that used a patient involvement approach using a patient tool to combat the HAI. The results show a decrease of HAI in the hospital from 78% to 28%, and an increase in handwashing among healthcare professionals. This will bring the management and finance on board (Lastinger et al. 2017).

During this stage, patients in the ward will be approached and briefed on the change proposal and their role and involvement as a lifesaving opportunity will be explainned (Trampuz and Widmer, 2017). Their role is to observe if those involved in their care decontaminate their hands before coming into contact with them. If not they have the right to ask them to wash their hands. Incase  they fail to  challenge them they can show them the patient hand hygiene leaflet tool with HIA information. The hand hygiene leaflet tool will have a bold colourful heading written ‘Stop have you washed your hands’?

Patients’ views and contribution will be recorded so that they will be embedded in the proposed change. Patient Feedback sheets will be shown to them, and the colourful badges that the staff will be wearing will also be shown to them. To workers new badges written ‘You can ask if l have washed my hands’ will be shown to them. They can make contribution regarding the badges and any adjustment will be taken into consideration.

 

 

Change

This is the second stage of the framework, this is where the full process of change takes place, and this is a transition phase where staff begins to embrace the proposed change, with positive motivation. Healthcare staff begins to adjust to the new working environment (Spear, 2016).

The experiment will begin on a small scale, in two bays of the ward, this will allow any adjustments to be done before full implementation to the rest of the ward bays.  Healthcare professionals are expected to wash their hands as soon as they enter the bay and approach the patient. After examining the patient, they are expected to wash their hands and remove any protective clothing such as aprons and gloves. This process should be repeated on every patient they come into contact with. The healthcare staff will be wearing their badges

At the beginning of the shift, feedback sheets will be given to the patients and a patient hand hygiene leaflet tool. The feedback sheet comprises questions on healthcare professionals’ handwash compliance if they washed in between patients and leaving the bay and if they were able to ask the healthcare professionals if they washed their hands. To make the process of feedback easy for the patients the questions will be closed questions consisting of yes or no boxes to ticks.

At the end of the day shift, feedback sheets are collected from the patient, evaluation through the feedback will be done the following day to determine the next phase of the implementation and small wins will be recorded, this will guide the implementation further (Spear, 2016). Discussions will be done with the management on the success of the first phase of implementation, any concerns raised on the feedback will be discussed, any adjustments will be made (Spears, 2016). At this stage, the full implementation of the change to the whole ward will begin.

Refreezing

At this stage, the change that has been enacted is sustained. The goal is for the healthcare professionals to consider the new change as the status quo. The organisation’s old culture of not being consistent in handwashing thereby causing the increase in the HAI will be transformed to the new state (Bazok, 2013). The new changes of healthcare professionals wearing ‘ ayou can ask if l washed my hands’ badges and being challenged by the patients will be tied into the new culture which becomes the new norm, To sustain the change long term there is a need to promote and develop strategic ways such as a feedback process, developing a reward system, and ongoing support for the healthcare staff ( Bozak, 2013). Finally, success should be celebrated by offering rewards to those healthcare staff adapting to the new status quo (Bazok, 2013).

Barriers to change

In practice implementing change often meets many barriers, as cost, fear, and resistance to change can arise from top managerial to staff members (Chun-Mei and Li, 2017). Healthcare professionals may perceive this change as disruptive to their work, embarrassing, uncomfortable, and tension might develop between them and the service users (Seale et al. 2016). Healthcare staff may feel their professionalism is being questioned (Prittet et al. 2017). Managers might resist due to cost involved in inmplementing a change. However, involving the managers, staff in change planning, decision-making will result in acceptance of the change and its importance to patient safety and its benefit outweigh cost involved  (Bozak, 2013).

This experiment can face resistants from patients, they can perceive confronting or challenging professionals giving them care as embarrassing (Seale et al. 2016). The patient might see their involvement as a potential threat to the patient-provider relationship (Seale et al. 2016) However, the introduction of badges to healthcare professionals in the ward written ‘You can ask if l have washed my hands’ will ease patients’ concerns and leads to a mutual partnership between patients and healthcare professionals (Kim et al. 2015). However, to support staff and patients throughout the change process the PDSA tool as mentioned above will be utilised to manage and monitor the change.

Quality Improvement

To achieve a successful quality change improvement a suitable quality tool should be used. Planning Do Study Act PDSA is defined as an improvement tool model that utilises a structured cycle that enables testing out of implemented changes on a small scale before wholesome implementation (Taylor et al. 2014). The tool consists of 4 phases and its suitable for this implementation due to its small-scale review testing which will be done in 2 ward bays before wholesome implementation (NHS,2018). The planning stage is where the objective of the change is clearly stated, and those involved in the change the staff and patients will be briefed on what is expected of them in combating the HAI (NHS, 2018). This is followed by the do stage, where healthcare staff engages in the new norms washing their hands each time they come into contact with patients (NHS,2018). Feedback from patients of the events will be recorded. At the Study phase, the feedback is collected, and data analysed compared to the predictions (NHS,2018). The impact of the change is reflected through a detailed summary of what has been learned. The final stage is the act, the decision to act will be made and the full implementation to the whole ward will take place (NHS,2018).

 

 

Leadership

A well-planned change process requires leadership that defines a vision and motivates others (Al-Sawai, 2013). Leadership is defined as an individual influence to achieve a common goal in an organisation (Al-Sawai, 2013). A leader to execute a successful change should communicate clearly and widely, empower, and promote action and, as much as possible include others (Jui-Chen, 2015). Good leadership aligns people to a common goal, empower and motivates people towards achieving a goal (JuiChen, 2015). Good leadership coordinates, direct and, supervise organisation staff performance of a set task (Jui-Chen, 2015).

Democratic leadership will be used in this change process because it is effective, it involves each member in decision-making and allows members to have equal say and exercise authority (Jui-Chen, 2015). It establishes trust and vision, understands employees’ resistants, and has confidence with the organisation members to accomplish a goal. (Northouse, 2016). This type of leadership is appropriate because its approach is preferred in this proposed change. Its democratic approach in incorporating patients and healthcare staff in decision-making is very crucial in implementing change. It encourages patients and healthcare professionals to share their views and resistants in open transparent communication (Cottey and McKimm, 2019). However, this type of leadership consumes time and can be difficult for the leader to accommodate every idea from staff members, but its benefits outweigh the disadvantages (Northouse, 2016).

The autocratic style of leadership approach is defined as authoritative leadership which is characterised by control of decision-making by an individual. Employees are not consulted and they make their choices based on their judgment and ideas. It uses the punishment of employees approach as a way of influencing them (Sfantou et al. 2017). Subordinates are expected to obey instructions without receiving any explanation and are to follow directions and a decision within a specified time decided by the leader, this type of leadership is rarely effective regarding this proposed change implementation (Sfantou et al. 2017). However, it allows the decision to be made quickly, communication to be reached directly to the employers due to one individual making decisions, and fewer administration levels to be informed (Sfantou et al. 2017).

The Laissez-Faire style of leadership is defined as a hand-off style, that provides little or no direction to employees, and low accountability (Skogstad et al. 2007). This approach expects employees to implement the change in their way without a proper set plan. This type of leadership is not appropriate because when employees do not have a plan to follow there will not be any coordination of work and no accountability (Skogstad et al. 2017) However, this leadership empowers employees to implement change in a way they see fits.

Evaluation

Evaluation is defined as a systematic assessment carried out to find the impact of a change implemented (NHS,2017). It is a rigorous way of finding the effectiveness of implemented change through gathering information (NHS, 2017). This can be done using a different approach. This proposed change will utilise data collection using feedback sheets from patients and healthcare professionals (NHS, 2017). Also, a clinical audit will be done, by comparing the figures of HAI before and postimplementation to see if there is a reduction in HAI. Evaluation outcomes can lead to the implementation of the same change in other wards and hospitals.

Conclusion

Quality improvement is important in hospitals, it increases the quality of care, patient safety, and better patient outcomes. Implementing a change should be done using appropriate change models and change tools that guide the implementation taking into consideration employee’s resistance and barriers to implementation and appropriate measures to overcome them should be applied. Communication is the key to a successful change, communicating effectively utilising an available mode of communication leads to a better understanding of the proposed change by the employers. The leadership style to be used should critically be chosen, a wrong leadership style leads to difficulties in implementing the change. Evaluating the change is a fundamental part of the implementation, this will show the effectiveness and impact of the change. Evaluation leads to the implementation of the same change to the other wards or hospitals as an evidence-based quality improvement.

Referencing

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Kim, M.K., Na, S.H., Shin, M.J., Lee. H.S., Kim, C.J., Song, K.H., Choe, P.G. and Park, W. B. (2015) Discrepancy in perceptions regarding patient participation in hand hygiene between patients and health care workers. American Journal of Infection Control. Vol 43 (7) pp. 510-515.

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Quality Improvement Project Work

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Proposal for change to improve hand hygiene compliance among healthcare professionals through patient empowerment to reduce healthcare acquired infection in hospital settings

Introduction

Hand hygiene is a highly emphasized health practice in all healthcare settings to be adhered to by both care providers and patients as well. The rationale for this recommendation is based on the fact that hand hygiene is reported to be highly effective in preventing Health Acquired Infections (HAI) in healthcare facilities (de Kraker et al., 2022). However, adherence to this practice is still law among primary healthcare stakeholders, particularly patients. This low adherence has led to a growing prevalence of health acquired infections (HAI) among patients and health care providers (Suzuki et al., 2020). The trend is attributed to inadequate support and empowerment programs for patients to comply with hand hygiene guidelines. Implementing these programs, for example, the Multimodal Hand Hygiene Improvement Strategy (MMIS) proposed by World Health Organization (WHO) to enhance hand hygiene require many changes in a healthcare facility along with effective leadership to ensure success (Lenglet et al., 2019). As such, this paper will implement a leadership change in a healthcare setting to empower patients to be more adhering to hand hygiene requirements and, in turn, ensure the prevention of HAI.

Justification for the Proposed Change

Empirical evidence shows that hand hygiene has undoubted effectiveness in reducing or preventing the prevalence of HAIs among patients and health providers (McGuckin and Govednik, 2013). As such, hospitals should strive to implement hand hygiene programs to protect both patients and health providers from contracting HAI (Arntz et al. 2016). In most cases, hand hygiene practices have been given in form of clinically recommended guideline programs by bodies like WHO and the Center for Diseases Control and Prevention (CDC) to provide ease for patients and care providers while complying with hand hygiene and ensuring effectiveness. For healthcare facilities to comply with these programs and recommendations, changes must be incorporated to install the required equipment and tool for effectiveness (Tan and Jeffrey, 2015). Additionally, an effective leadership system is necessary to enforce the requirement, provide oversight, and ensure committed compliance to the hand hygiene guidelines (Rodriguez et al., 2019).

Therefore, the approach that this paper will take to enhance hand hygiene by considering the change and leadership aspects, is not misplaced. Implementing hand hygiene tools like the ones proposed by WHO, the Multimodal Hand Hygiene Improvement Strategy (MMIS), and the Hand Hygiene Self-Assessment Framework (HHSAF) required hospitals to make considerable changes, including System Change, Training and Education, Evaluation and Feedback, Reminders in the Workplace, Institutional Safety Climate, and provision of handwashing points and detergents (Lee et al., 2019). A change is certainly called for to ensure the transformation of any healthcare facility into a hand-hygiene-compliant one.

Implementing any change require a well-defined change framework that will guide the change of interest (Hussain et al., 2018). This study will apply Lewin’s change model to implement the proposed change. Implementing a change is always associated with various challenges, including, resistance, acclimatization, and uncertainties (Pittet, 2017). Rushing to implement a change without applying an effective change model such as Lewin’s change model may lead to errors, including overlooking important aspects of the process (Tang, 2019). Therefore, it is necessary to apply a change model while implementing a change to ensure success. Lewin’s model – Unfreeze – Change – Refreeze will be used because it is reported to be highly effective in mediating the implementation and leadership initiatives for change in complex organizations (Muldoon, 2020).

Background

It is widely reported that hand hygiene has not fully been implemented in many healthcare settings as recommended. This has led to an increasing prevalence of hospital-acquired infections (HAI) because hand hygiene prevents and reduces the occurrence of these diseases (Boyce et al., 2019). Globally, it is reported that hundreds of millions suffer from HAI. This is ironic because, people expect to receive treatment from a healthcare setting but instead contract these infections, HAI that are associated with higher health care costs, longer stays, and greater morbidity rates, thereby jeopardizing patient safety. According to Kraker et al. (2022), Up to 2·6 million HAIs occur every year in the EU and European Economic Area, resulting in more than 91 000 deaths. In the United States, the number of HAI cases is 1·7 million, resulting in about 99 000 deaths.

Such cases continue to grow amidst calls for hospitals to embrace hand hygiene. Unfortunately, compliance with hand hygiene is still low at 70% in high-income countries and 9% in low-income countries, despite its effectiveness at addressing HAI (Kraker et al., 2022). Various bodies, including WHO and CDC, have responded to this challenge by developing hand hygiene programs for patients and care providers to comply with to improve hand hygiene practices across the globe. WHO launched the Multimodal Hand Hygiene Improvement Strategy (MMIS) along with the Implementation Toolkit, which includes the Hand Hygiene Self-Assessment Framework (HHSAF) in 2009 to improve hand hygiene practices (Chassin, Mayer, and Nether, 2015). Despite the widely reported efficacy of these programs at enhancing hand hygiene, they have not been fully implemented.

Lee et al. (2019) report that these hand hygiene programs have not been fully implemented because they are driven by human behavior and must be within the organizational and socio-economical context of a health facility. As such, compliance requires modification and adjustments of such aspects. Compliance is also affected by leadership engagement, peer pressure, and role modeling (Lenglet et al., 2019). Consequently, the success of the implementation of the hand hygiene program requires proper change management and leaders to implement the shift and ensure its success. This will ensure that the recommended structure, equipment, and chemicals are provided, while educating patients concerning how to perform the practices, encouraging them to abide by the recommendation, and monitoring their compliance (Suzuki et al., 2020).

Therefore, this paper aims to propose a change that will improve hand hygiene compliance among healthcare professionals through patient empowerment to reduce healthcare-acquired infection in hospital settings (Rodriguez et al., 2015). The change will be guided by a specific change model, Lewin’s model to ensure the change is logically undertaken and no error is made or a point is left unattended (Pinkham, 2015). The proposed change will try to implement the WHO Multimodal Hand Hygiene Improvement Strategy (MMIS) and the Implementation Toolkit, HHSAF launched in 2009 (de Kraker et al., 2022). Such a move will require the consideration of the leadership aspect of the facility that will spearhead the change process.

Change Framework

The implementation of the WHO Multimodal Hand Hygiene Improvement Strategy (MMIS) and the Implementation Toolkit, HHSAF launched is nothing short of a complete change within a health facility (Suzuki et al., 2020). Some of the requirements for compliance include:

  • System change: that entails restructuring and the provision of necessary infrastructure, such as continuous water supply, soaps, accessible alcohol-based hand rubs, and towels to ensure hand hygiene compliance.
  • Training/education to inform patients and care providers about the hand hygiene program, its importance, and how to do it.
  • Evaluation and feedback may require the facility to install CCTV cameras and sensors at the handwashing points to monitor compliance to hand hygiene.
  • Reminders such as billboards, posters, and manuals about hand hygiene.
  • Institutional safety climate for safety consideration and hand hygiene.

Implementing all these requirements will require changing the hospital infrastructure and people as well to be hand hygiene compliant. Such a change is complex and will require due diligence to ensure success. This is why a change model must be involved to ensure every aspect of the process is effectively covered. This proposal has chosen Lewin’s model because it is easy to understand and simple to implement (Rosenbluth et al., 2016). It has three basic steps, including unfreezing, changing, and refreezing (Moran, Hernandez, and Sutton, 2020). Lewin believes that change involves creating the perception that a change is needed, then moving toward the new and desired level of behavior, and finally solidifying the new behavior as the norm (Pittet, 2017). The feasibility and effectiveness of this assertion in promoting change have seen it being employed widely to guide a change process.

Unfreezing Stage

This state involves the prior preparations that are made to make people ready for the change and willing to embrace it. This stage is important in informing people that the proposed change is necessary to avoid resistance. Awareness creation is done at this stage to inform relevant parties that the status quo or the current level of acceptability is not safe for both patients and care providers (Moran, Hernandez, and Sutton, 2020). Evaluation of the present situation can be done to inform these parties that it is unsafe and needs to be changed. Communication and education are paramount at this stage. As people get to know about the change, they get to understand that it is necessary and urgent, and, in turn, feel motivated to embrace it.

In this study, this stage will involve educating both patients and care providers on the importance of hand hygiene. Their perception and knowledge about hand hygiene will also be evaluated to determine the extent to which training and sensitization should go. A baseline survey will be conducted to establish the present prevalence of HAI in the hospital. Evaluation and feedback will also be involved at this stage by monitoring the available infrastructure that can support hand hygiene and reporting performance feedback to communicate the gap that exists (Rodriguez et al., 2015). The management, care providers, and patients will be allowed to give their views concerning HAI and hand hygiene and guide the implementation process.

Changing

This is the second stage in Lewin’s Model in which the transition or movement to the new state begins. It follows the unfreezing, and it is believed that parties involved are now ready for the change because they have been prepared for it (unfrozen) (Pinkham, 2015). The change is actualized, and as people struggle to acclimatize to the new reality, fear and uncertainty may arise to challenge the move (Moran, Hernandez, and Sutton, 2020). As people begin to learn the new processes, behaviors, and ways of thinking, they will require time, continuous support, education, and communication to get used to it and realize success.

As for the implementation of hand hygiene, the move will be implemented in bits starting with two wards. Hand washing points will be installed at all entrances, soaps, and alcohol-based hand rubs provided. CCTV and sensors will be installed to enable monitoring of the progress (Shen et al., 2017). People will be trained on how to implement the MMIS and HHSAF as recommended by WHO. Billboard and flyers containing summarized procedures and demos will be posted on convenient places, including the handwashing point, walls, and notice boards to act and reminders and instructions. Training and reminders will also include the WHO “My Five Moments for Hand Hygiene” (Shen et al., 2017):

  • before touching a patient
  • before the clean/aseptic procedure
  • after body fluid exposure risk
  • after touching a patient
  • after touching a patient’s surroundings

Additionally, weekly meetings will be organized to report how patients and care providers are complying with the change (Shen et al., 2017). People will report the challenges they face and give recommendations on how to address them. Such reports will guide continuous adjustments to be implemented however necessary as recommended by both patients and care providers to offer more convenience and efficiency (Rosenbluth et al., 2016). In the meetings, people will report their level of compliance, explain why others are not complying, and suggest the necessary punishments for non-compliance and rewards for compliance. Evaluation will also be done on a weekly, monthly, quarterly, and annual basis to determine the impact of the changes. Sensors, CCTV, hand hygiene feedback sheet, and leaflets will be used for evaluation to give compliance reports and frequency (Boyce et al., 2019)

Refreezing

This is the final stage of the Lewin Change Model which involves reinforcing, stabilizing, and solidifying the new state after the change. During this state, the implemented changes are refrozen and accepted as the new normal (Pinkham, 2015). The healthcare facility will make more efforts to ensure that people do not revert to the old practice and ensure the new ways are perpetuated as the organizational culture.

In the implementation of the hand hygiene program, this stage comes after the piloting of the move and the realization of its importance and necessity. Additionally, at this stage, the hospital shall have done enough adjustments to know what works and what does not and ensure that the retained practices are feasible and practical within the hospital context (Arntz et al., 2016). The hospital will give this practice as a policy and ensure to reprimand non-compliance and reward the best compliance. Not only will hand hygiene practice will be incorporated into the hospital culture, but also continuous training, monitoring, and evaluation to eliminate laxity and trivialization of the changes made after some time. Evaluation of the HAI case will also be done to monitor the impacts of the changes on preventing HAI and remind people why they need to keep hand hygiene.

Barriers to Change

Barriers to change are some of the primary challenges that the hospital will have to face as it moves to implement the change. No change undergoes a smooth transition because there is always some resistance (Raistrick, 2014). The program will change the status quo of the facility and will require some additional costs to actualize. The management may find it hard to implement and sustain this change due to the regular expenses it will incur from this move. Additionally, patients and care providers may see this as a disruption from their normal routine and unnecessary bother and, in turn, decide to boycott it. Additionally, acclimatization to the changes may take a long time since both patients and care providers are not used to these practices (Parsons et al., 2016). The fear of failure and infectiveness may hinder the full implementation of the program due to the associated demotivation, thereby acting as a barrier. As the change enters the freezing stage, people may consider it an unnecessary bother and lower their commitment to compliance (Appelbaum et al., 2017). These are some of the challenges to change that will need to be continuously addressed to ensure long-lasting success. Addressing these barriers will require continuous training, motivation, monitoring, and execution of the change program to ensure that the relevant stakeholders do not lower their guards on complying with hand hygiene requirements.

Quality Improvement

The primary focus of this program is to improve the quality and safety of both patients and healthcare practitioners by lowering the occurrence of HAI. Achieving this goal will necessitate the employment of an effective quality improvement model to ensure a continuous improvement of the recommended practices (Mitchell et al., 2017). The U. S. Department of Health and Human Services defines quality improvement as “…systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” (Awaji and Al-Surimi, 2016).

This study will apply the plan-do-study-act (PDSA) cycle for quality improvement purposes. This model work in steps that revolve around making a hypothesis (plan), testing the hypothesis (do), examining the results (study), and reporting the results (act) (Picarillo, 2018). This will be a continuous practice after the implementation of the program by collecting relevant data such as the number of HAI reported within a given period and comparing it with the level of compliance to determine the relationship (Rai et al, 2021). The finding will inform the next action to be taken to get better results which will then be evaluated subsequently as the cycle continues.

Leadership

The success of this project will depend on the type of leadership and leaders who will spearhead the change. Leaders take the frontline in ensuring the success of an organization (Rosenbluth et al., 2016). The type of leadership style adopted by these leaders also goes a long way to impact the success of the project (Hargreaves and Ainscow, 2015). Leadership involves changing and improving the way the hospital will grow while focusing the attention of stakeholders on the problem at hand.

Choosing the best leadership style may be influenced by the organizational factor (Alqatawenh, 2018). After considering all factors, this study opts for the implementation of transformational leadership. Transformational leadership is praised for its effectiveness in lowering resistance to change. It is also recommended for large-scale organizational change because it is embedded in inspiring passion to embrace change with positive energy (Rosenbluth et al., 2016). It instills employee confidence and trust and motivates them to take charge of the change rather than imposing it on them. The project will outline the leadership style to be adopted, and the leadership qualities leaders should embrace and uphold.

Evaluation

Ellingson et al. (2014) define change as a continuous and systematic assessment of certain variables to determine the impact of an action taken. Since the hand hygiene program will be implemented with the sole purpose of preventing and reducing cases of HAI, evaluation is necessary to check whether it is achieving the intended goal or not (Ward et al., 2014). Various empirical methods will be employed for assessment, for instance, a baseline survey will be conducted before the implementation to determine the prevalence of HAI in the hospital, the knowledge of patients and care providers about HAI, and the associated financial and health implications of HAI (Ellingson et al., 2014). The same procedure will be repeated 3 months after the implementation of the hand hygiene program to check if there is any positive progress or not. Continuous assessment will be done on an annual and quarterly basis to check on subsequent progress (Cure and Van Enk, 2015). The necessary data will be obtained from books of account, health records, clinical audits, questionnaires, computers, and the installed sensors and CCTV.

Conclusion

Even though HAIs continue to be a growing problem in most hospitals, this should not be because, with proper hand hygiene, HAI is widely reported to be kept at bay very effectively. Hospitals should strive to implement a standard hand hygiene program to reduce the case of HAI among primary health stakeholders. The fact that this is not happening to the required capacity needs to be further investigated and addressed at the root cause level. Implementing the WHO-recommended hand hygiene program mostly requires healthcare facilities to undertake a full change given its requirements. Therefore, the success of such a change depends highly on the types of change model and leadership style chosen to implement the programs. This is why this proposal has chosen change and leadership aspects of HAI management to help mitigate the prevalence of these diseases. At this stage, the impact of this approach is promising but inconclusive since it is yet to be implemented.

 

 

 

 

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