Are you ready for a disgusting fact:  Most doctors and nurses—highly trained and respected professionals—wash their hands less than half as often as they are supposed to when working with patients (Gawande, 2007).

Stew in that for a minute.

Imagine the doctor caring for your mother in Intensive Care.

There is better than a 1 in 2 chance that he just finished checking an open sore or changing a filthy bandage on a patient down the hall and has stopped in quickly to check on Mom without bothering to wash his hands.

Think about the nurse who has been so wonderful for the past few weeks, gently washing your mother’s face with cool water to lower her temperature.

There’s better than a 1 in 2 chance that she just finished doing the same with a patient who has pneumonia two rooms over and hasn’t made it to a sink yet.

Considering that bacteria counts on the average hand range from 5,000 to 5 MILLION parts per square centimeter, those careless hand washing practices aren’t simply irresponsible—they can be downright deadly, passing infections around hospitals to uninfected people at alarming rates.


What’s really crazy is that hospitals are CONSTANTLY working to improve hand washing practices in their facilities.

Many have gone as far as to install alcohol rinses and gels in every room, knowing that alcohol rinses are more effective and efficient than traditional scrubbing with soap and water.

Most monitor hand washing practices, posting results and reminders on almost every surface in every unit across their hospitals.

Some go as far as to hire staffers whose sole job is to make unannounced visits to individual floors in an attempt to hold doctors and nurses accountable for their choices when it comes to hand cleanliness.

But few have ever bothered to ask doctors or nurses why they’re so careless about such a simple and effective practice.

That’s exactly, however, what industrial engineer Peter Perreiah did when he was put in charge of a small, 40-bed surgical unit at one of Pittsburgh’s veterans hospitals. “Peter didn’t ask, ‘Why don’t you wash your hands’,” one doctor reported, “He asked, ‘Why can’t you?”  (Gawande, 2007, Kindle Location 308-313).

The answer—which will come as no surprise to classroom teachers and school leaders—was time.

As it turns out, doctors and nurses are pretty busy people.

Often in charge of monitoring the progress of dozens of patients on several different floors of large hospitals, just making rounds in a timely fashion can be a challenge.

Add to that challenge the almost constant struggle to find needed examination supplies—gauze, tape, gowns, gloves, medical tools—in each of the dozens of rooms that they are responsible for visiting, and it is easier to understand how doctors and nurses were skipping a hygienic step that should never be skipped.

So Perreiah—in true engineer fashion—set out to make changes that would address each of the concerns that his doctors and nurses had identified as time sinks preventing them from consistently maintaining the highest hygienic standards.

As Atul Gawande explains in his 2007 book Better: A Surgeon’s Notes on Performance:

(Perreiah) came up with a just-in-time supply system that kept not only gowns and gloves at the bedside but also gauze and tape and other things the staff needed, so they didn’t have to go back and forth out of the room to search for them.

Rather than make everyone clean their stethoscopes, notorious carriers of infection, between patients, he arranged for each patient room to have a designated stethoscope on the wall…

He made each hospital room work more like an operating room, in other words.  (Kindle Location 308-317)

Perreiah’s changes had remarkable results.  Within one year, infection rates for MRSA—the contagious bacterial infection most likely to lead to death in hospitals—fell almost 90% in his ward (Gawande, 2007).

The story doesn’t have a happy ending, however. 

Despite showing that infection rates could be successfully addressed by making simple changes to save doctors and nurses time, Perreiah’s changes failed to take hold in other wards and on other floors in the same hospital.

Even worse, when Perreiah left his original unit two years after beginning his experiment in hand washing, performance took a nosedive.

Turns out that Perreiah was just as important to the improvements in hygiene on his unit as the changes that he had made—and once he’d left, the commitment to the changes wavered.

Interesting stuff, isn’t it?

And chock-a-block FULL of lessons for school leaders attempting to implement professional learning communities.

Here’s two:

Principals that are successfully STRUCTURING PLCs spend time listening to their classroom teachers about the challenges of implementing new processes and practices.

I have been around the PLC movement long enough that I’ve sadly seen PLC implementation done wrong far more often than I have seen it done right.

And the failure that I see the most frequently is school leaders who mandate new practices from the principal’s office—collaborative meetings, SMART goal writing, data collection and analysis, identifying essential objectives—without ever listening to their teachers.

The result:  Overwhelmed teachers buried under new behaviors that they are poorly prepared to implement.

When they raise concerns, however, their painted as whiners or resisters or fundamentalists.  Heck—popular thinkers go as far as to argue that they should be thrown off the collective bus when they don’t comply with school directives.

That kind of stubborn refusal to listen to practitioners has gotten hospitals nowhere, hasn’t it?

With average rates of hand washing compliance hovering around 70 percent—even as hospitals hire compliance experts to make “hand washing interventions” on every floor—inadvertent infections are appallingly common.

Perreiah’s approach was different, though.  Instead of falling into the “leadership by harangue,” approach so common in hospitals he took the time to learn from practitioners—and then aggressively attacked the implementation challenges that they identified.

And that’s what YOU should be doing, too.

Trust the knowledge and opinions of your practitioners because that knowledge is the closest reflection of the current reality in your building that you have.

And then make it your job to aggressively attack—rather than openly doubt or willingly ignore—the PLC implementation challenges that they identify.

THAT’s what leadership REALLY looks like in action.

Principals that are successfully SUSTAINING PLCs develop organizational leadership skills within their faculties.

The story of Perreiah’s success is really nothing more than a story of failure, isn’t it?  After all, the progress made on his original unit wasn’t sustained.

Sure, reducing infection rates by 90 percent for two years is pretty darn admirable work—but if the change can’t outlive the leader, was it really a change at all?

Sadly, successful PLCs often suffer from the same kinds of stumbles when they lose their leaders—and that’s because the leaders of PLCs generally do a poor job planning for their own departures.

How can you avoid making the same mistake?

The most important step is to start to distribute leadership from the day that you get hired.  Find teacher leaders and cultivate them.

Build their knowledge around leadership and PLC concepts.  Put them in charge of important committees.  Allow them to make key decisions—even when you aren’t completely sold on the decisions that they are invested in.

Ask them to act like leaders.

Have them defend the rationale for choices that they believe in based on your school’s mission and vision. Encourage them to be influencers—developing relationships that they can use to drive change later.

And then document EVERYTHING that your faculty believes in.

Tie your building’s choices to detailed rationales that can be shared with new principals when they replace you.  Make time to sit down with those principals—as well as the influential teachers on your building—early in their tenure.

By engaging in these practices—essentially crafting a detailed exit strategy from day one—you can help to ensure that the changes in your building outlive you.

Does any of this make sense?  Can you think of any other lessons that we can learn from the story of dirty hands in hospitals?

What barriers to you think school leaders face when trying to structure and/or sustain PLC initiatives?

How are you—or your principals—successfully addressing those barriers?



Work Cited:

Gawande, A. (2007). Better: A Surgeon’s Notes on Performance. New York, NY: Metropolitan Books.

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