Stop. Point, and Cross

A few months ago, I had the opportunity to tour the Toyota Motor Manufacturing Kentucky, Inc. (TMMK) plant in Georgetown, Kentucky.  Toyota builds the Lexus ES350, Avalon, and Camry at this plant.  TMMK is Toyota's largest automobile manufacturing plant in North America - the plant itself covers over 7.5 million square feet (that's about 156 football fields, according to the website) and is staffed by over 7,000 employees.  The Toyota team builds nearly 2,000 vehicles every day!  The tour is completely free to the public - it is a popular field trip destination for local schools. 

I was very impressed with the amount of traffic inside the plant!  Employees and managers were either walking around or riding on bicycles, golf carts, or forklifts.  Our tour was riding around on a long tram.  The intersections were as busy as any intersection in America!  As the tour guide stated in his introduction to the plant, safety is the main priority at this plant.  He specifically asked us to look out for employees when they came to an intersection.  Look for the employee to "Stop, Point, and Cross."  Every time a worker came to an intersection, he or she would stop, look both ways, point in the direction that he or she was going to move, and then cross the intersection.  What impressed me the most was that the workers did this each and every time.  Every time I looked, they did it!  It was so in-grained that they didn't stop to think about NOT doing it.

I started thinking to myself - health care is so very different.  We can never quite reach above 90% on our handwashing compliance - at either our hospital or even throughout our industry.  What is Toyota doing that every worker universally and without fail, "stops, points, and crosses"?  Why can't we get this same level of compliance in health care when it comes to handwashing? Several of us on the tour noticed this level of compliance and asked the same question.  My only response is that the culture is very different, perhaps, at TMMK.  I later found out that workers are incentivized (or in some cases, penalized) for complying with this particular safety initiative.  However, I don't think that is quite sufficient.  There is something deeper there.  Several hospitals that I know use employee incentives to encourage compliance with handwashing - yet, compliance is never quite 100% (and in some cases, it is actually far lower than 100%).  It has to be the culture at Toyota!  It has simply become an expectation of everyone who works at the plant.

How do we build this kind of culture in healthcare?  I suspect that Toyota started by being relentless about their "Stop, Point, and Cross" initiative.  Employees were accountable not only to themselves, but also for their fellow employees (something that has been called "200% accountability").  Whenever someone forgot to "stop, point, and cross" - they were called out for not doing so.  How many times in the hospital does a physician get "called out" by another physician or a bedside nurse for not washing his or her hands?  We simply need to do better.  We need to make handwashing automatic, just as TMMK did for "Stop, Point, and Cross."  But it all starts with culture.