Introduction
Novant Health is an organization with a comprehensive and developed management. The organization includes a network of clinics in four US states, which have various subspecialties. The company has a multi-stage structure, including a board of directors, which reports to the heads of each of the clinics that manage the rest of the hospital staff. The board of directors is focused on solving the problems of investment and logistics, intervening in the management of hospitals only through regulatory documents. Then, the heads of each institution have subordinate managers responsible for managing departments and divisions within each clinic. These department managers coordinate the work of doctors, nurses, and technical and IT staff.
Novant Health hospitals have specializations in the areas of therapeutic services, pediatrics, and traumatology. Trauma clinics are a model for successfully integrating IT into workflows, including diagnostic and care tools. Pediatric clinics focus on highly qualified specialists with education in several fields. Notably, Novant Health provides horizontal interaction between clinic managers for joint learning, sharing of experience, and professional development. This approach distinguishes the network of clinics and allows for providing a consistently high quality of services and a unified approach common to all institutions.
Identifying the Healthcare Problem
In most cases, Novant Health clinics follow the guidelines and have no difficulty complying with regulations submitted by the board of directors. Recently, however, clinic leaders have drawn attention to the urgent need to improve hand hygiene compliance. Hand hygiene, by definition, is a system of practices that clinics perform to meet the generally accepted standards for ensuring the safety and health of patients. Hand hygiene terminology considers concepts of ‘hand-washing schedule’ and prevention of ‘transmission of infections.’ Notably, Herzberg’s Motivation-hygiene two-factor theory could be applied to address the problem. This theory implies that job satisfaction comes from success in the performance of duties, while job dissatisfaction can be associated with barriers to career or professional development. Therefore, the development of policies to motivate health workers maintaining hand hygiene should consider the ideas associated with this management model.
So far, employees are showing low levels of handwashing for several related reasons. According to studies, these reasons include the need to frequently change locations when entering and leaving rooms and a short time spent with patients (Clancy et al., 2021). Wearing gloves reduces the tendency to wash hands, as many workers perceive them as a sufficient means of protection. Just as importantly, the logistics of alcohol dispensers and sinks, as well as breakdowns and late refills, result in reduced compliance rates. Some employees may have allergies or skin irritations caused by disinfectants. Healthcare workers often move items around the clinic, such as medications, instruments, or notepads, and their hands can be constantly full, while sinks and dispensers lack shelves for such items.
Stakeholders Most Impacted by the Problem
Remarkably, even a small number of employees who do not follow the rules of handwashing endanger the health of patients and healthcare workers. Poor handwashing practices can lead to the spread of infections within the hospital. The first group of stakeholders to suffer from hand hygiene non-compliance are hospital patients and healthcare workers who may be contaminated with infectious diseases. In addition, non-compliance with handwashing practices leads to economic losses due to patient dissatisfaction and deterioration in the image of the clinic. Therefore, clinic leaders and the board of directors are the second group of stakeholders who will suffer from non-compliance. The third potentially vulnerable group of stakeholders are family, acquaintances, and friends of employees and patients who are equally exposed to the spread of infectious diseases.
Socio-Ecological Principles Applying to Healthcare Management Decision-Making
The socio-ecological principles help determine how health care practices affect broader ecosystems, such as local communities, the environment, the urban community, and state and federal health care. The socio-ecological model provides a framework for applying the understanding of a multi-level society and the interaction of people in social systems (“The social-ecological model,” 2022). Therefore, the prevention, intervention, and control of various policies must consider different socio-ecological levels. Interestingly, the Centers for Disease Control and Prevention require introducing new policies and management decisions with a social-ecological model in mind.
The missions associated with the introduction of new practices within the framework of the model include improving the quality of services provided and the health of patients, which entails improving the health of local and wider social groups. Notably, tolerance and awareness of human rights violations, gender values, socio-cultural norms, attitudes, hopes, and beliefs strengthen the motivation for change (Olden, 2019). Therefore, the application of a social-ecological model in the implementation of changes positively affects complex ecosystems such as local communities and improves the environment.
The Role of Management’s Responsibilities in the Change Process
Some critical resources will be needed to implement the plan of hand hygiene compliance successfully. Notably, clinic leaders will have a primary role in making decisions about implementing change. In particular, clinic leaders will develop a common strategy in collaboration with the healthcare administrators. Then, this strategy will be presented to the board of directors and delegated to subordinates through the hierarchical and horizontal chains of command processes.
Clinic leaders will be responsible for overall strategy implementation and change, and the quality of the strategic plan. Clinic department heads will be responsible for implementing the changes at local levels and for overseeing the quality of the implementation. Heads of departments and subordinates who will be affected by the changes will make proposals for strategic and tactical decisions. Subordinates, including nurses, doctors, technical staff, and IT workers, will be responsible for implementing the requirements and practices recommended. Patients, upon admission to the hospital, will also be required to familiarize themselves with the rules of handwashing.
Health administrators will have a special role in assisting clinic and departmental leaders in strategy development and oversight. Notably, healthcare administrators are typically responsible for ethical issues and are involved in strategic planning, decision-making, and change management (Barr & Dowding, 2019). Healthcare administrators at Novant Health will also subsequently evaluate the strategy and refine some of the tactical steps to implement it (Duffy, 2018). Mid-level and lower-level administrators will be responsible for more detailed development of tactical steps to implement the change strategy within day-to-day operations and functions.
Why the Resolution of the Issue is Sufficient
The implementation of the solution will rely on the use of various techniques and control tools to reduce the level of non-compliance. In particular, the healthcare administrators will ensure that the progress of strategic change is adequately measured and evaluated. From there, administrators will distribute weekly questionnaires to staff, with questions about the frequency of handwashing, and reasons for non-compliance with the rules. Within a month, shortcomings in the strategy may come to light, and it is good if the staff can report them. At the end of the month, the level of the spread of infectious diseases among patients who stay or have left the clinic will be recorded to compare with the level of diseases before the implementation of the strategy.
The first concern is that questionnaires about the handwashing schedule are not enough to check the hygiene state. It is possible to introduce a plan of handwashing in every hospital room where the physician or the nurse should write down their surname and time after washing hands. Even though this action is additional work for the healthcare personnel, it might help them develop the habit in several weeks. After the pattern is established, it is possible to disregard writing surnames in the schedule after washing hands.
The second initiative that might increase the positive motivation of the employees to wash hands regularly is establishing a ritual that is obligatory for everyone who approaches the patient. For instance, every employee should know that the first action they should take when communicating with the patient is washing hands. When every person in the hospital is aware of this ritual, there is no space for variations in this case.
As mentioned in the paper, healthcare professionals can disregard alcohol dispensers and sanitizers because of hand allergies and irritation. It is critical to give healthcare personnel enough options to wash their hands using warm running water and soap. Moreover, hand sanitizers are less effective in preventing infection from spreading than handwashing with soap. Every room in the hospital should have convenient sinks, hand driers, and shelves to put papers and medical tools to facilitate this process and make it an integral part of the employees’ daily routine.
Conclusion
Thus, a report on coping with the problem of hand hygiene in the Novant Health clinics was presented. The positive outcomes of the strategic changes addressing the hand hygiene issues will include lower infection levels, while the negative outcomes may feature dissatisfaction among employees. To implement and adapt the solution, the strategy will be developed by clinic leaders with input from the healthcare administrators. This strategy will be approved by the board of directors and presented to all employees. The success will be monitored and evaluated by the healthcare administrators.
References
Barr, J., & Dowding, L. (2019). Leadership in health care. Sage.
Clancy, C., Delungahawatta, T., & Dunne, C. (2021). Hand-hygiene-related clinical trials reported between 2014 and 2020: A comprehensive systematic review.Journal of Hospital Infection, 111, 6-26. Web.
Duffy, J. R. (2018). Quality caring in nursing and health systems. Implications for clinicians, educators, and leaders. Springer Publishing Company.
Olden, P. (2019). Management of healthcare organizations: An introduction. (3rd ed.). Health Administration Press.
The social-ecological model: A framework for prevention. (2022). CDC. Web.