Hand Hygiene Implementation Plan Using Lewin's Change Model

Introduction to the Implementation Plan

It is important to understand that plans do not simply manifest themselves into existence — a specific implementation effort is needed to ensure that the evidence presented in research can be applied to practical ends. Although the solution appears clear and succinct, putting this plan into action requires a plan of its own. To do this effectively, Lewin's model of change theory can assist in describing how this plan will be put into action and significantly complement what needs to be done in order to realize success.

The plan itself is simple and revolves around Lewin's trinity of components in his change model. Lewin essentially proposed that change occurs in three distinct stages: an old idea is "unfrozen," then processed, and eventually "refrozen." This model of understanding mental processes applies at both a collective and an individual level, signifying the importance and effectiveness of this approach. The model must make use of identifying constraints that push and pull toward the poles of defined boundaries, and an equilibrium point must also be identified to locate the practical benefits of the model and create a system with known and tangible boundaries.

In this case, the first step of change requires the nursing staff to "unfreeze" their previous conceptions about the efficacy of hand washing and its importance in the healing process. Jeanes (2009) suggested that this first step of change is ultimately very important and requires a marketing or selling effort. She wrote, "Hospital-acquired infections are an important cause of morbidity and mortality in hospitals. Hand hygiene is a vital measure in the prevention of these infections, but attaining compliance with hand hygiene requirements can be difficult. Our approach of 'selling' hand hygiene to staff by adopting traditional marketing methods produced a sustained effect. Work is now taking place to measure compliance with the use of the hand-cleansing products." Once established, this mindset can be changed within the hearts and minds of the nursing staff, and a new idea may be formed and frozen into the collective psyche of the hospital ward.

Resources Needed

Although the implementation plan is largely an abstract and mental process, physical resources must be attained and utilized to bring it to life. The first action required will be the formation of a committee comprising nurses, educators, managers, the infection control department, and patients. This committee will need time and funding to reach an agreement on a hand-washing reform plan that synthesizes all the needs and restrictions represented by its members.

This committee is expected to produce a written standard operating procedure outlining solutions to the identified problems. Questionnaires will be used to gather data about staff knowledge of CAUTI prevention and catheter care bundles. Additionally, all nursing staff in the ICU will be specifically surveyed to produce more applicable data from the questionnaire responses. Keeping Lewin's theory of change in mind, the transformation that must collectively occur may take time to take hold. Practice makes perfect, and ensuring that corrective actions aligned with the newly developed policies are consistently followed will help make this implementation a success.