Texas Children's has an employee bonus program called P3. Previously, all incentives were based on financial numbers and volume, but Starke went to his administration and talked it into making hand hygiene part of the bonus program for employees. Then he took it one step further and made it part of the administrator's bonus program as well.
"I know this sounds trite, but we convinced them that it was the right thing to do," Starke says. "We said, 'What's good for the goose is good for the gander,' and once you agree to do this for the employees, how can you possibly exempt yourselves? [We were] sort of trying to create a 'just culture,' and I think this is a very important part of 'just culture,' that administrators be just as responsible for these things as the frontline employees are."
The facility had to meet a 95% compliance rate for employees and administrators to get that portion of their bonus, while other factors contributed to other portions of their bonus.
Since implementing this incentive, compliance rates at Texas Children's have stayed between 95% and 99%, Starke says. Simultaneously, bloodstream infection rates have plummeted. Although Starke admits there are other factors to account for this reduction, it has helped set the culture and emphasize infection prevention.
"It's not like there are administrators browbeating people," Starke says. "It's not like people are up there going, 'If you don't do this, we can't vacation this year.' It's creating the same culture and expectations at every level of the organization, and I think that's sometimes where [infection prevention] falls down, is not making executives responsible."