Hand Hygiene Case Study: Nebraska Medicine

See how Nebraska Medicine uses Watershed to ensure hand hygiene compliance while saving time and money.

Nebraska Medicine operates in the highly regulated healthcare industry, where hand hygiene audits play an essential role in keeping patients and staff safe.

This case study explores how Nebraska Medicine’s Office of Health Professions Education (OHPE) switched from pen and paper checklists to modern digital observations using Watershed’s learning analytics platform and Xapimed (a mobile observation checklist app outfitted with xAPI).

The Challenge

The healthcare industry has strict hand hygiene compliance regulations, which are continually monitored across various teams, departments, and settings.

Historically, Nebraska Medicine’s Infection Control team has evaluated and recorded handwashing activities through direct observation. An observer would use pen and paper to check off items and then submit that sheet of paper to someone else, who would manually enter that data into a tracking system.

These observations could take someone anywhere between one week to a month to add to the system. So not only was this process time consuming, but it also lacked real-time results and was prone to human error. This meant there were lags in having the most up-to-date compliance data and in providing the remediation and follow-up to those in need of training.

As a result, the team needed a turnkey solution that streamlined the data collection process for observers and provided accurate, real-time results required for any needed interventions.

The Solution

Using the WHO’s Five Movements of Hand Hygiene and a regimented rubric for collecting hand washing information, the team developed a training program for 530 hand hygiene observers—which is designed to ensure inter-rater reliability for observers to know how to perform an observation and collect information objectively.

By including physicians, nurses, physical therapists, and entry-level healthcare professionals (e.g., certified nursing assistants, patient attendants, etc.) across the organization, the team created a series of training videos to introduce relatable scenarios that are familiar to all audiences across Nebraska Medicine. In other words, these scenarios are practical examples of what happens all day, every day during the patient care process and beyond.

This example shows what observers see when using the Xapimed app on their mobile devices to complete hand hygiene observations. The app records and submits observation data to Watershed for in-depth reporting and analysis.

Furthermore, these videos help explain that these audits are not punitive. Observers aren’t “secret shoppers” trying to get someone in trouble. Rather, these audits are meant to help everyone learn and grow while keeping patients and staff members safe.

Each video simulation scenario is used as a practice observation and includes examples of missed opportunities that need to be identified using a checklist app powered by Xapimed, which records observations. A scenario plays out on one side of the screen while the checklist is on the other side. This allows observers to get a feel for real-world audits.

The training includes a self-assessment and a digital certification badge once the training is successfully completed. Once training is complete, viewers receive feedback explaining what was correct and what was missed.

Using Xapimed, direct observation and data collection are completed on a mobile device. Data is time-stamped and auto-uploaded to Watershed’s Learning Record Store and can be instantly accessed in the Watershed dashboards. This contributes to aggregated data (allowing trends to be highlighted by department, job role, etc.) and highlighting if someone needs corrective action.

Additionally, making these observations on the app reduces the need to carry around a pen, paper, and clipboard. And as they’re conducted on mobile devices, observations feel more “natural” in a clinical environment—meaning people don’t behave differently because they think they’re being monitored.

The Results

The switch to a digital checklist (accompanied by video-led training) saw a dramatic 15% in observations carried out in just 6 months. The resulting real-time data capture enables swift analysis and preventive action as needed.

Each Xapimed observation includes real-time data collection using Watershed—a process that previously required someone to manually upload the data and could take up to a month to complete. By removing the manual data collection process, they’re significantly reducing the chance of potential errors. The time saved through automating this process equates to an estimated $4,050 per month.

The program has shown incredible adoption rates thanks to its ease of use; an initial 130 observers soon increased to 530 in less than a year. As a result, more people could complete more observations than before—including those in entry-level roles, who were also presented with new self-directed learning paths. Furthermore, this approach continues to spread knowledge across more roles, builds trust between colleagues, and cements Nebraska Medicine’s approach to building a learner-centric focused workforce that can ultimately aid staff retention.

Senior stakeholders can monitor real-time, on-demand results powered by Watershed’s dashboards, enabling them to observe general trends and apply swift interventions for individuals as needed. Additionally, learners can view the aggregated results as they train, helping them visualize the importance of carrying out observations and better understand their roles in the larger ecosystem.

This Watershed report shows details from Nebraska Medicine’s hand hygiene observation program—including dates, locations, and applicable commentary.
Increased efficiency and adoption

Since launching the initiative, the efficiency of this method has seen incredible adoption:

  • 130 observers increased to 530 in less than a year, a 307% increase.
  • Implementing single sign-on technology further enhanced the user experience and enabled the easy adoption of using the solution on mobile devices.
  • The instantaneous nature of being able to quickly and easily perform and submit an evaluation also means that observers can quickly and easily get back to their jobs. They can simply observe, submit the information, and then return to work.
On-demand, reliable data for instant insights

Collecting this type of data in Watershed enables the team to stratify that data at a very real, granular level and, in turn, take the required actions.

  • The team can identify trends by role, area, and time of day so they can determine needed interventions—such as remedial training—or celebrate best practices.
  • This data also allows the team to better understand and replicate the best practices in areas that are doing extremely well with their hand washing/infection prevention protocols.
  • Furthermore, rather than collecting information on paper and manually aggregating that data in a spreadsheet—which could take up to a month—the team can look at this information in real time.
  • Being able to collect and present current data means quicker interventions.
  • Instant updates provide critical real-time information, which senior stakeholders can review at a glance.
  • Human error from manually entering data is nearly nonexistent.
Efficiencies that save time and money

By removing the manual data collection process, the team significantly reduces the chance of potential errors. And people save time by being able to easily and quickly observe, submit, and enter data.

  • Turnaround time for the observation and data entry process has been cut in half.
  • The time saved through automating the observation and data entry processes equates to an estimated $4,050 per month.
  • Managers can view custom reports anytime they want without additional assistance.
Reinforcing a learning culture

Due to the successful adoption of the process, new self-development paths have been created for the wider range of entry-level roles that are now carrying out observations.

Sharing live results with learners helps build a culture of responsibility.

Learners in other cohorts access real-time benchmark data (via a link to Watershed dashboards) to help them visualize the impact observations have in the workplace. This practice helps link training to outcomes and helps learners understand correlations with performance.

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