Creating a Culture of Safety through Institutional Climate Change
Improving hand hygiene practices in healthcare settings is a critical global priority, as it serves as a fundamental preventive measure against the spread of infectious pathogens and healthcare-associated infections (HAIs). However, achieving and sustaining optimal hand hygiene compliance remains an ongoing challenge worldwide.
To address this, the World Health Organization (WHO) has championed a multimodal hand hygiene improvement strategy (MMIS) that encompasses five key elements: (1) system change, (2) training and education, (3) evaluation and feedback, (4) reminders in the workplace, and (5) an institutional safety climate.
Consistently, the institutional safety climate element has ranked the lowest among these interventions, with no significant differences observed between high- and low-income countries. This suggests a critical gap in our understanding of how to effectively cultivate and maintain a healthcare environment that prioritizes patient and worker safety through hand hygiene improvement.
Reaching International Consensus on Research Priorities
To identify priority research areas for enhancing the institutional safety climate within the context of MMIS, WHO convened a structured consensus process involving a diverse panel of 57 international experts. This Delphi study, conducted over two rounds, aimed to reach agreement on a comprehensive research agenda that can guide future investigations and inform policy decisions.
Round 1: Identifying Key Thematic Areas
In the first round, the expert panel reviewed an initial list of 36 research priority statements across five key thematic areas:
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Safety Climate/Culture Change: Exploring the role of safety climate during outbreaks/emergencies, the relationship between an institution’s safety climate and hand hygiene improvement, and the influence of media/social media in shaping the institutional safety climate.
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Personal Accountability for Hand Hygiene: Evaluating the impact of an enabling environment and effective monitoring/feedback mechanisms on personal accountability, as well as the influence of leadership approaches in shaping individual accountability.
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Leadership: Assessing effective leadership and governance structures in cultivating a culture that supports hand hygiene improvement, and the impact of infection prevention and control (IPC) training for hospital leadership.
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Patient Participation and Empowerment: Identifying effective methods for patient engagement and their influence on the institutional safety climate and hand hygiene improvement.
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Religion and Traditions: Understanding how wider societal factors, including national and organizational culture, religion, and traditions, shape institutional practices and impact hand hygiene initiatives.
Round 2: Refining the Research Agenda
In the second round, the expert panel reviewed the ratings from the first round and reached consensus (defined as ≥70% agreement) on 31 of the 36 research priority statements. The remaining 5 statements, primarily in the “Religion and Traditions” domain, did not achieve consensus.
Key Priorities for Enhancing the Institutional Safety Climate
The research agenda that emerged from this consensus-building process highlighted several critical areas for further investigation:
Effective Leadership and Governance
Experts agreed on the need to explore how leadership support and robust governance structures can shape an institutional safety climate that prioritizes and sustains hand hygiene improvement initiatives. This includes understanding the drivers that influence an organization’s commitment to hand hygiene as a patient safety priority.
Societal Norms and Institutional Practices
The panel emphasized the importance of examining how wider societal factors, such as national and organizational culture, religion, and traditions, can influence institutional practices and shape the safety climate surrounding hand hygiene. Addressing these contextual factors is crucial for developing effective, culturally-appropriate interventions.
Personal Accountability and the Built Environment
Experts identified the need to evaluate how the built environment (e.g., availability of hand hygiene materials and equipment) and effective monitoring/feedback mechanisms can enhance personal accountability for hand hygiene among healthcare workers. Exploring the role of leadership in fostering individual accountability was also deemed a priority.
Leveraging Media and Social Media
The panel recognized the potential of media and social media to influence the institutional safety climate and drive hand hygiene improvement. Further research is needed to understand how these platforms can be strategically utilized to stimulate behavior change and sustain a culture of safety.
Safety Climate During Outbreaks and Emergencies
The COVID-19 pandemic has underscored the importance of understanding how the healthcare facility’s safety and quality climate affects hand hygiene practices during critical periods, such as outbreaks and public health emergencies. Addressing these knowledge gaps can inform targeted interventions to strengthen preparedness and resilience.
Patient and Civil Society Engagement
Experts reached consensus on the need to identify effective methods for empowering patients and engaging civil society to contribute to hand hygiene improvement efforts. Exploring the interaction between national cultural characteristics and patient/community participation was also deemed a priority.
Charting the Path Forward
This comprehensive research agenda, developed through rigorous international expert consensus, provides a roadmap for addressing the critical knowledge gaps surrounding the institutional safety climate and its role in enhancing hand hygiene practices worldwide. By focusing on these priority areas, researchers, clinicians, policymakers, and funding bodies can collaborate to drive tangible improvements in patient and healthcare worker safety.
Implementing this research agenda will require a multidisciplinary, collaborative approach that brings together stakeholders from diverse backgrounds, including infection prevention and control, infectious diseases, microbiology, patient safety and quality, and research and academia. Leveraging the expertise and insights of this global network will be essential in translating the identified priorities into impactful, evidence-based interventions.
Ultimately, the success of hand hygiene improvement efforts hinges on the ability to create and sustain a healthcare environment that prioritizes patient and worker safety as a foundational element of quality care. By addressing the research priorities outlined in this agenda, we can unlock the transformative potential of the institutional safety climate to drive meaningful and lasting change in hand hygiene practices, ultimately safeguarding the health and well-being of communities worldwide.
