Monday, January 15, 2007

The best laid plans

You know, sometimes you just can't win. You try something for the best of all reasons, and it just blows up in your face. Or, in this case, it rips up right in your hands. A sign of good management is when you realize a mistake and correct it quickly. (Yes, our folks are available to advise the Bush administration!)

Here's the story.

A hospital is like a small city. Thousands of people live and work in close proximity and engage in a full range of activities and, yes, bodily functions. BIDMC's facilities people are terrific, always looking for ways to enhance our basic services to improve safety, reduce costs, and have less impact on the environment. Here was their first message a few weeks ago:

On Monday, we will launch a program to replace our paper towel dispensers with new battery-powered, "hands free" dispensers. These new dispensers reduce the chance of cross contamination and thus facilitate improved infection control. We also expect them to save money (since the amount of towel dispensed is set at a pre-measured length and minimize instances when users pull more paper towels than needed.)

Good stuff, right? Wrong. The complaints started piling in. It appears that the new paper towels were too flimsy and would disintegrate in people's hands. You might think that the CEO would not hear about this issue, but I actually received as many email complaints about this item as I have about anything in the last five years. Maybe it is because I have been strongly encouraging people to wash their hands. (See "Clean Hands" posting below, on November 1.) Maybe because holding a damp, torn piece of paper is a really unpleasant experience for people.

Here is today's message from our facilities team:

As you may recall, last month we e-mailed you about the plan to convert the campus paper towel dispensers to a hands-free model, designed to improve infection control and potentially reduce waste of paper towels. Along with the change in dispenser (and thus vendor) was a change in the paper towel itself (to one made from recycled materials in our effort to be more environmentally responsible and that was offered with the new dispensers at a cost savings). These new paper towels were put in the new dispensers but also started to be used throughout the campus.

Clearly, this change in paper towel was not a positive one as it was not strong enough to meet our needs. We tried another one which also did not meet our needs, although did slightly better in the hands-free dispenser. Our apologies for the problems and frustrations this has caused.

We have come to an arrangement to revert back to the strength and quality of our previous paper towel choice while maintaining the option to use hands-free dispensers. We will be converting ALL areas back to the stronger paper towel this week.

I say, good for our facilities people to be creative with new approaches, and good for others to let us know when something doesn't work. I will only start to worry about our place when (1) people stop trying to make improvements and (2) when people stop complaining. Fortunately, neither is in the cards!


Anonymous said...

Hi Paul--

Thanks for this! I've been meaning to write you about this with the subject "What doesn't work", but it looks like everyone else beat me to it.

The real unpleasant experience isn't the damp paper -- it's that trying to put on exam gloves with anything but bone dry hands is frustrating and often painful -- I would invite you to try it a few times to get the picture!

I think that's a great start to improve the paper towel quality, although to be honest, I wonder whether the amount that is dispensed and/or lockout time will continue to be an issue -- I'm certainly happy to try this, and it's definitely a step in the right direction.

Thanks again for your efforts to fix this - and please keep an open mind as we see whether that's sufficient for the clinical areas with rapid turnover, such as the ER.

Daniel Sullivan said...

I would like to see us continue to use recycled paper. It just needs to be thicker!

Anonymous said...

It's nice to see an organization admit to problems and make a correction rapidly. In so many organizations this doesn't happen.

Susanne S-S said...

Where is your quality improvement team? I would hope that institution-wide changes would be tested on a small scale prior to full implementation!

Anonymous said...

They were, but no comments were received from the pilot areas.

Labor Nurse, CNM said...

Here's my thoughts on this paper towel stuff:

I think that the automatic paper dispensers are great! They have been popping up in lots of places (like some of your fellow hospitals, malls, and even places like the Texas Roadhouse!) and even though they dispense about 8 inches of paper towel, most people will go for one more wave of the hand to get another 8 inches. I've yet to notice anyone do three waves of the hand, because, well, I suppose no one has the time! So the worry of waste is not an issue.

I've not run into the disintergrating paper issue, but sorry I can't remember any brand names.

Actually, I am happy to see any type of paper towels in public restrooms, etc, because I can't stand those blowers. Yuck! For some reason those just don't seem sanitary. (BTW, I've noticed them at BIDMC in some of the public restrooms, like near the Souper Salad in the Shapiro. I was none too happy to use that).

I also have a suggestion:
PLEASE place a waste basket right beside the door to restrooms. That way those of us who do not want to touch the dirty door handle after we've just washed our hands can use the paper towel to open the door, then just drop the paper towel in the trash. (As opposed to carrying it with you until the next trash barrel, which always seems to be miles away in my case.)

Anonymous said...

I agree with the last comment about the air blowers and the location of the trash barrels. I was conducting an employee evaluation last week, and when I commented on the hand hygiene safety goal, the research assistant mentioned her frustration with trying to wash her hands properly. She said that she had trouble in bathrooms with the blowers because she either couldn't turn off the water with a paper towel or couldn't open the door with a paper towel. She also said that when there are paper towels available, the trash can is often on the opposite side of the room as the door, so she has to take her paper towel with her when she leaves the bathroom if she doesn't want to touch the door handle directly. I told her that I would pass on this information to our Healthcare Quality and Patient Safety team. I suggest that someone in environmental services look into these issues since proper hand hygiene is one of our most important safety goals.

Anonymous said...

Have they also considered the maintance cost of these dispensers? such as batteries, and electronic failures, paper jams.


Anonymous said...


Jonathan Vafai said...

I actually like the thinner paper because it is softer. What bothers me is that you only get 8 inches of it, with a second wave, 8 more inches, and then it seems to lock out. I am not sure that the thicker paper is that much more absorbant.

Regarding paper towels and the doors, I also agree, having bins near the doors is good. Either way, don't forget to use the alcohol-based hand rub after you use the restroom.

Anonymous said...

I visited the BIDMC not long ago and used the restroom. I had the most pleasant experience drying my hands
with a turbo charged blower.
It was like a leaf blower.
I plan to revisit soon and hope it is still there , not some puny towels.


Dry Hands

jhadow said...

When I visited Japan in the fall to present at a medical conference, I was amazed by many things. One which consistently amazed me was the quality of equipment in the bathrooms! Nearly every toilet I used in the entire country was automatic flush. Many didn't have external doors, but instead relied on multiple corridors (like at US airports). But the technology that is germaine to this discussion is their super-high powered hand driers.

I hate hand-driers in the US. McDonalds is notorious for not giving an opinion in many of its retraurants of towels vs driers. The hand driers they do use (is there a national contract?) are weak. It not only takes much longer than paper towels to use these, but I often have to push the wet (and dirty?) button a second time (I usually use my elbow or shoulder) because the drier stops before my hands are dry.

I had none of these problems in with the Japan driers. They were activted by infared sensors and used a much higher powered jet of air which instead of relying on heat and friction (like the US designs) use focused air to blow the water off your hands. This was great because not only was it quicker, but didn't leave your hands feeling like the skin was going to crack.

I had some trouble with the language, but using the restroom in JP was definetely much easier and sanitary.

I must also say that I'm happy to see that I'm not the only one with poorly designed bathrooms on my list of pet-peeves.