Friday, May 01, 2009

Tag, you're it

A fun game, for serious purposes, invented by the folks in our Emergency Department, set forth in an email that went out last night. I don't recall seeing anything like this in the best practices report prepared by the Joint Commission. A good humored use of peer pressure among a group of doctors who tend to be really good at noticing things. Let's see how it works!

In order to remain vigilant about hand hygiene, patient contact etc. we will be implementing a game of tag. At the beginning of each core shift the ED Attending will clear the banner, and during that shift if a person (ED MD) is caught or "tagged" violating a patient safety mandate, their name will be placed on the banner as being "it" until they ID another MD who failed to meet hand hygiene, documentation or other targets. If at the end of a shift the "it" person has not been able to ID another MD who has violated the rules, the banner will be cleared and started again. This will start tomorrow at 7am May 1st. As of now only the attending or nursing can change the banner, so please ask the attending to update the banner as people are tagged.
A few simple suggestions;
1) Use first names only on Dash Board Banner
2) Keep the language appropriate (i.e. "Dan is it" or some similar version as the rest of the hospital sees the banner)

Let the game begin.


Paul said...

It will be interesting to see if this works. I hope, Paul, that you post an update. I would guess that nobody will do it because working as a team I would think that ratting someone out would be against that. But, who knows, ED people are quirky folks. They might just like it. The question is: will it work?

REKording said...

Good idea. Friendly competition is a fine way to engender good habits. Now if we can just stop folks from using "air" handkerchieves.

Anonymous said...

We'll see, paul. A friend jokingly sent this note: "People can get very passionate when playing such games – knocking over an elderly patient to tag a violator, screaming 'gotcha' and doing a celebratory dance….."

Richwlf said...

From the ED perspective, I find Paul's comments quirky.
The entire staff embraced the game enthusiastically in the first hours and a number of people were tagged. There is no punishment attached for being "it" so it is not viewed as "ratting someone out". Instead the providers see it that way it should be seen, with humour. If that is quirky, then I'm glad to be lucky to work with so many quirky people.
There is healthy competition developing between the categories of providers: attendings vs. residents vs. nurses vs. techs. So far we have not knocked over any elderly patients, but no promises.
I agree that proof of the validity of the exercise will depend on this exercise leading to providers adopting compulsive habits once we are beyond the first few days. It will be some time before we can assess this. But so far, so good.

KirstenB said...

I echo what Rich has written, this is a fun , friendly game and all are engaging.... MDs, RNs, Techs, Registration staff, and the Unit Coordinators. People are having fun with this and paying attention to their own practice, as well as every person coming through our department.

Anonymous said...

I give this one first prize for sheer inventiveness. Now, what can the other medical staff departments do to top that??!! The surgeons surely ought to be able to come up with something, maybe involving sharp instruments.... (:

nonlocal MD

Anonymous said...

How did the game emerge? Whose idea was it - who played a role in putting it toghether?

Christian Sinclair said...

If you don't have a electronic board for everyone to see (like in a nursing home) you could come up with some inconspicuous item (sticker on a name badge) that staff recognize as being it.

Richwlf said...

How did this come about? As Chief of the ED there was growing pressure to get this right. The drive to eliminate harm, recent DPH citations in other areas, and our culture of transparency was causing us to strive for perfection in hand hygiene. Considerable training, daily e-mail communications, and town hall discussions, along with random audits were performed to try and achieve compliance. However the ED has such a rapid flow of patient-provider contacts (any provider to be in compliance in the ED may need to wash hands up to 8-12 times/hour) that it is much harder than one might think to get there. With all the distractions that trip up providers from being 100% compliant, we were far from eliminating the problem.
Since the entire ED leadership team works in the department, there was a clear personnel understanding by everyone of the need to make compulsive hygiene practice a reflex more than a mandate. To do this, you really need to get everyone to watch everyone else. New providers are most often educated into our societal culture by people who may be just 1 or 2 years ahead of them. So we needed a method that would ensure that everyone remediated everyone else. You can't ensure this change in behavior through threats or compulsion. That will simply ensure that you burn out and loose your physicians and nurses. A game of tag seemed to be a good way to make this change in culture fun, and have everyone actively participate. But the final proof is in the pudding. It really is our multidisciplinary management team in the ED that developed it and made it functional. I'll take credit for the initial idea if it works and if it does not, I'll find someone else to blame it on. : )

76 Degrees in San Diego said...

Why not just sing along:

Anonymous said...

You guys are amazing .... taking something as simple as hand hygiene (well, thought it was simple!) and making it competitively FUN. That's the "Hook" that's needed in mostly every behavioral education moment. You got this one right. Keep us posted on how it goes.
Kevin @ Einstien