The focus of this thesis is an exploration of the ontology related to the issue of improving hand hygiene through dialogue and wonder based means of intervention.

Problem statement
Hand hygiene is a central element in infection control where patients become victims of a hospital-acquired infections. In the region of Northern Jutland alone, this problem require more than 100 additional beddings per day with an estimated annual cost of 75.000.000 DKK. Naturally, the region has put a lot of effort into improving the hand hygiene compliance of healthcare workers, and several campaigns have been launched in an attempt to raise attention in the hospitals. Despite this, the number of infections has not been decreasing.

In collaboration with Aalborg University Hospital, we studied the phenomenon throughout 2014 and concluded that an epistemological approach is inadequate for improving hand hygiene. Our findings indicated that interventions should also address ontological perspectives and therefore, we pointed to a ‘Hygiene Workroom’ as a base for a phenomenological approximation of the ontology in regards to hand hygiene. Thus, the object of this thesis is both to design and explore the Hygiene Workroom as a way of intervening. Furthermore, we wish to present and discuss the findings brought about in this exploration on a dialogue conference, in which we assemble several stakeholders. This leads us to the following problem definition:

How can we together with practitioners work with the ontology of the organizational actions of hospital-acquired infections at Aalborg University Hospital in a Hygiene Workroom and a dialogue conference, and what findings crystallize in this process?

Scientific approach
The thesis builds on the philosophical hermeneutics as taught by Hans-Georg Gadamer and Martin Heidegger. Our intervention is inspired by the thoughts of Knud Ejler Løgstrup’s ethical demand and Kari Martinsen’s understanding of ontological evidence. With this combination of theorists, we have chosen action research as our general approach and C. Otto Scharmer’s Theory U as the theoretical basis for understanding the hand hygiene problem.

The Hygiene Workroom and findings
The Hygiene Workroom is an adaptation of ‘Kunnskapsverkstedet’ by Finn Thorbjørn Hansen and Inger Erstad. During 4 sessions, we facilitated a group of healthcare workers through an educational process based on their own professional experiences, and the goal was for them to develop a deeper understanding of their underlying assumptions. Together with the healthcare workers, we found the key insight that the denotation of hand hygiene, to be clean, is replaced by a mythological connotation of being good which leads to a sense of absolution among the practitioners even when they perform a merely symbolic hand disinfecting procedure. Furthermore, the dominant mythology also purges other ideas of change by deeming them wrought with guilt as it sees hand hygiene as good in itself.

The dialogue conference and findings
Our 3-hour dialogue conference, which is inspired by Søren Frimann and Ann Bager’s methodical guidelines, relies on Scharmer’s thoughts on involving the ecosystem - the collective field revolving the problem. Thus, it had over 40 participants from many different organizations ranging professionally from a hospital CEO to politicians and healthcare workers. We facilitated states of debate and dialogue and added open space technology by Harrison Owen in order to make possible that something entirely new could emerge within our assembly. We found that a priori perceptions of hand hygiene can create blindness to the actual reasons for not performing the correct procedures. During the latter part of the conference, we experienced an opening towards this blind spot; here the participants began to look at their own part in upholding a system, which is maintaining the problem as a method of self-preservation.

Overall new findings
In conclusion, the improvement efforts of hand hygiene in the Region of Northern Jutland are characterized by a blind spot. Change initiatives here only assess the functional process of hand hygiene, but never the sources from where the hand hygiene actions come from. Hereby, even well-meant change initiatives are actually maintaining the status quo. Although they are just initial steps, our Hygiene Workroom and the dialogue conference indicated the possibility for new types of cross-organisational collaborations by revealing a collective willpower among stakeholders to start listening to the ethical and existential dimensions of the hand hygiene practice of healthcare workers in Northern Jutland.

Keywords: Hand hygiene, philosophical hermeneutics, ontology, Theory U, the Hygiene Workroom, dialogue conference, social innovation, blind spot