The document outlines a patient safety campaign at Tufts Medical Center aimed at improving hand hygiene to reduce hospital-acquired infections, which claim 90,000 lives annually in the U.S. The campaign, featuring the slogan 'speak up. wash up.', was developed through extensive research and targeted communication strategies to engage both staff and patients, achieving significant increases in hand hygiene compliance. Key components included localized messaging, visible leadership involvement, and a variety of educational materials to foster a culture of accountability among healthcare providers.

1. Marketing Patient Safety Within Your Hospital David Fairchild, MD, MPH, Tufts Medical Center Dan Dunlop, Jennings Healthcare Marketing October 1, 2009

2. Bert Jacobs, Life Is Good!

3. In the Spotlight: Hand Hygiene & Hospital Acquired Infections Statistics 90,000 people die each year of hospital acquired infections $4.5 billion in excess costs 1 in every 22 patients gets a hospital acquired infection; approximately 1.7 million patients/year Medicare and private insurers no longer reimbursing hospital acquired infections By eliminating one case of hospital acquired infection, you can save enough money to pay for a hand hygiene campaign

4. In the Spotlight: Hand Hygiene & Hospital Acquired Infections

5. In the Spotlight: Hand Hygiene & Hospital Acquired Infections

6. Tufts Medical Center Two full-service hospitals Tufts Medical Center, academic medical center; 451 licensed beds Floating Hospital for Children, renowned children’s hospital Urban setting - downtown Boston Roughly 5,000 employees

7. Tufts Medical Center: Context for the Patient Safety Campaign Lackluster, inconsistent results on hand hygiene Various campaigns on different floors No consistent monitoring Need to develop a patient safety culture Joint Commission coming Market watching

8. Pre-Campaign Hand Hygiene Compliance Numbers Baseline pre-campaign compliance of 71% for January and February 2008 Compliance averaged 73% in 2007 Poor ‘Before Care’ compliance relative to ‘After Care’

9. Existing Campaigns Within Tufts Medical Center

10. Existing Campaigns Within Tufts Medical Center

11. Existing Campaigns Within Tufts Medical Center

12. Existing Campaigns Within Tufts Medical Center

13. The Cluttered Environment Within Tufts Medical Center

14. Our Assessment Pointed to the Need to Drive The Message Home Doctors and nurses know they need to wash their hands Not an educational issue, but rather a forefront of mind issue We needed to hammer this message home The revelation: “This is about me!”

15. Challenges of a Culture Change Seeking behavior change – most difficult “marketing ask” Need to communicate washing before and after patient care, and any time in the room Many different audiences in many different places with many different opinions Few places to communicate to just employees – patients and families exposed to almost all messages; hospital a “serious” place, have to be sensitive

16. A Comprehensive Campaign Required Monitoring Competition and accountability Breakthrough, consistent creative Advocates on the floors A commitment from the top A willingness to “do something different”

17. The Campaign Development Process Research Creative brief Spec campaigns Presentation to Safety Leadership Council Development of winning campaign Campaign rollout

18. Research Interviews with key stakeholders within Tufts Medical Center Dr. David Fairchild, Chief Medical Officer Dyan Madrey, Development and Training Manager (HR) Barbara Curley, RN, Director of Performance Improvement Dr. Shira Doron, Professor of Medicine, Infectious Disease, Head of Anti-Microbial Management Team Terri Hudson Jinks, RN, MSN, Clinical Director of Adult Nursing Mary Sullivan Smith, Chief Nursing Officer & VP of Patient Care Tricia Lemon, BSN, MPH, Infectious Control Practitioner

19. Research: What We Heard Lots of clutter in the medical center - numerous initiatives and poster campaigns Need to make patient safety part of the fabric of employees’ lives Need to provide feedback to employees - data on compliance Existing tension - Colleagues uncomfortable reminding one another Patients and families intimidated by caregivers, don’t want to appear to be disrespectful Campaign should feel home grown

20. Research: What We Heard Need to communicate accountability and expectations Must be sustained over time; can’t be idea of the moment A sense of humor would help Must be highly visible graphically Must empower patients, families and employees

21. A Sample of Programs Reviewed Stanford Hospital Cedars-Sinai Medical Center St. Mary’s Medical Center (PA) Duke University Medical Center University of Iowa Hospitals and Clinics Beth Israel Deaconess Brigham & Women’s Johns Hopkins Vanderbilt UPMC

22. Research Existing Campaigns

23. Research Existing Campaigns

24. Research Existing Campaigns and Editorial Coverage

25. The Creative Brief Key Points: Campaign needs to accommodate a variety of patient safety messages, not just hand hygiene Break through the clutter; impactful without frightening patients and family “ Be with the employee” all day without blending into the woodwork Audiences: Employees - broad, heterogeneous audience; create the environment where it is okay to speak up; change behavior Patients & Family members - Overwhelmed with information; need to be given permission/empowered

26. The Creative Brief Key Points: Tonality: fun/positive, engaging and in your face Should not feel like a generic, off-the-shelf campaign Can’t become background Must be sustained Message: Hand hygiene is for everyone, every time; that means you!

27. Spec Creative A variety of approaches: four options Varying tonality Some more flexible than others moving forward Need to get approval of the Safety Leadership Council

28. Choices Campaign “ You’re making choices about hand hygiene and you want to make the right choice.” “ By the way, the right choice is obvious!”

29. Choices Campaign

30. Choices Campaign

31. Choices Campaign

32. Choices Campaign

33. Choices Campaign

34. Choices Campaign

35. Nametag Campaign Gives germs a human face!

36. Nametag Campaign

37. Nametag Campaign

38. Nametag Campaign

39. Nametag Campaign

40. Nametag Campaign

41. Germs Campaign Links germs to your behavior Conveys accountability

42. Germ Campaign

43. Germ Campaign

44. Germ Campaign

45. Germ Campaign

46. Germ Campaign

47. Germ Campaign

48. The Winning Campaign Speak Up. Wash Up.

49. Speak Up. Wash Up.

50. Speak Up. Wash Up.

51. Speak Up. Wash Up.

52. Speak Up. Wash Up.

53. A Local Campaign

54. The Winning Campaign Speak Up. Wash Up. Messaging speaking directly to: Physicians Patients & families Patient care workers Tonality: Positive encouragement for providers (not negative/guilt) Empowering for patients Encouraging peer communication Attention-getting Friendly

55. Speak Up. Wash Up. Location specific messaging: Patient rooms Staff lounges & bathrooms Public restrooms Mirrors Clinical areas

56. Speak Up. Wash Up. A variety of delivery vehicles: Stickers of varying colors, size and shapes Buttons Posters Monthly CMO email messages Newsletter articles Patient briefing sheets

57. Before We Started Baseline monitoring data by unit (critical!) Patient Safety Champions on every unit (physician and nurse) Know all the rooms on the units Hand Hygiene lecture for all employees with post test Annual updated education for nursing staff Educational lectures by staff in Infectious Disease Enhanced distribution of gel dispensers

58. Speak Up. Wash Up. Launch e-mail blast to internal audience

59. Speak Up. Wash Up. Important patients and families understood what we were doing

60. Speak Up. Wash Up.

61. Speak Up. Wash Up.

62. Speak Up. Wash Up.

65. What Worked Localizing the campaign: Stickers with photos of Tufts Medical Center leadership were a hit Campaign stood out graphically Bold colors and short messages Reporting compliance results/competition Using existing communication vehicles Variety of messaging for different audiences Visible involvement of leadership

66. What Didn’t Work Some stickers did not adhere to all surfaces The most edgy messaging was not well-received. Anything with slight sexual content or hard edge pulled. “ Take your dirty hands off me” “ Chairman do it in 15 seconds” “ Hellacious & Efficacious” Reception to campaign varied by department Posters were too heavy

67. Results

68. Results

69. Results The day finally arrived… Joint Commission visit in August 2008 No violations They left wearing our buttons!

70. Southern New Hampshire Medical Center Adopted Tufts’ Hand Hygiene Campaign Started with favorite stickers contest (March ‘09) May ‘09 campaign roll out Compliance increase May to July: Nurses 80% to 92% Physicians 71% to 87% Others 54% to 80% Stickers keep disappearing Now selling stickers in gift shop

71. The Ideal Hand Hygiene Campaign Employee education Letter to employees’ homes Presentation to department heads Email blast to employees Kick off parties - partner with vendor Local champions at the unit level Coverage in internal newsletter

72. The Ideal Hand Hygiene Campaign Celebrations on key dates: patient safety awareness week, handwashing awareness week, etc. Refresh campaign every few months Measure effectiveness; inspire competition Report results regularly to employees Signage everywhere: restrooms, break rooms, public areas, patient rooms, handwash dispensers, paper towel dispensers, etc.

73. Contact Information David Fairchild, MD, MPH, Tufts Medical Center [email_address] Dan Dunlop, Jennings (Healthcare Marketing) [email_address] Online Healthcare Marketing Community: http://HealthcareMarketing.ning.com Website: www.jenningsco.com Blog: http://TheHealthcareMarketer.wordpress.com