TY - JOUR
T1 - The evolution of knowledge exchanges enabling successful practice change in two intensive care units
AU - Rangachari, Pavani
AU - Madaio, Michael
AU - Rethemeyer, R. Karl
AU - Wagner, Peggy
AU - Hall, Lauren
AU - Roy, Siddharth
AU - Rissing, Peter
N1 - Publisher Copyright:
© Wolters Kluwer Health | Lippincott Williams & Wilkins.
PY - 2015/12/14
Y1 - 2015/12/14
N2 - Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.
AB - Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.
KW - change implementation
KW - communication and knowledge exchange
KW - culture of safety
KW - evidence-based management
KW - evidence-based practices
KW - infection prevention
KW - mixed-method research
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U2 - 10.1097/HMR.0000000000000001
DO - 10.1097/HMR.0000000000000001
M3 - Article
C2 - 24153028
AN - SCOPUS:84918812013
SN - 0361-6274
VL - 40
SP - 65
EP - 78
JO - Health Care Management Review
JF - Health Care Management Review
IS - 1
ER -