Monday, August 31, 2015

Clean 'em up: An approach to hand hygiene

Noticing the ineffectiveness of certain approaches to garnering hospital and doctor compliance with important safety standards (like hand hygiene), Brad Flansbaum offers an intriguing way to improve:

Assemble a moderately sized pod of hospitals, matched on demographics, payer, SES, bed size, etc., and keep them as geographically proximate as possible.  If they compete, even better.  Have them decide on a monitoring system they will purchase together at a discount (I hear vendors like big orders).  If CMS has a little seed money sitting in a slush fund, still better.  Alternatively, maybe even condition participation on a half-percent penalty give back from another program like the HRRP or VBP.

All the institutions must agree on the rules of the multi-year monitoring project, and each must publish their sum scores in a publicly accessible database (individuals would be held harmless for this endeavor).  The catch? The bottom performers pay a penalty into a patient safety fund–one significant enough to make the bean counters take notice, but not enough to discourage continued participation.

However, there is another catch: CMS cannot touch the lucre.  It funds worthwhile QI efforts of the mini-consortium, overseen by a self-appointed, representative board and approved by the Feds.
(Restrictions apply, of course, and the headline purchased by the victors in their local papers cannot read, “Hey losers, you owe us 5%.  Also, before you give us the check, wash your hands.  Oh yeah, prospective patients are forewarned.”)

Oversimplified?  Yes.  Crazy? No.  But you get the picture.

All kidding aside, regardless of how you monitor handwashing compliance, if penalties translate to individual and hospital hurt, financial or otherwise, folks must buy in.  The guts of any modern day solution will require technology and upfront costs.  Anything less will lead front-line providers to push back and harbor more ill will against a regulatory system they increasingly see as suffocating and harsh (read: n=10 on a core measure).  Occasional and mediocre monitoring just won’t do.

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