| April 22, 2009 | Media contact: Margarita Bauza E-mail: mbauza@med.umich.edu Phone: 734-764-2220 |
Hospital personnel and cultures hamper efforts to enhance safety, U-M study finds
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ANN ARBOR, Mich. - Hospital personnel and deeply entrenched organizational cultures can stifle efforts to prevent serious infections commonly acquired during hospital stays, a U-M study finds.
Findings of the study – which was funded by the Department of Veterans Affairs, Health Services Research and Development Service, and the Ann Arbor VAMC/University of Michigan Patient Safety Enhancement Program – appear in the May 2009 issue of The Joint Commission Journal on Quality and Patient Safety.
The work is important because infections lead to poor patient outcomes and prove costly for hospitals.
According to the Centers for Disease Control and Prevention, health care-associated infections, also known as HAI, lead to about 99,000 deaths per year and cost U.S. hospitals $6.7 billion per year.
Because many of these infections can be prevented, in October 2008 Medicare stopped reimbursing U.S. hospitals for the extra costs of caring for patients with commonly acquired infections, such as those associated with urinary and vascular catheter use, says Sanjay Saint, MD, MPH, director of the VA/UM Patient Safety Enhancement Program, and a lead researcher in the study.
The study aimed to determine what barriers exist in the implementation of new safety practices to prevent infections, focusing on the role played by hospital personnel and organizational cultures.
“We sought to understand why some hospitals appeared to be actively engaged in and committed to preventing infections while others appeared lackadaisical in their approach,” Saint says.
Researchers conducted in-depth phone and in-person interviews between October 2006 and September 2007 with 86 participants, including chief executive officers, chiefs of staff, hospital epidemiologists, infection control professionals, intensive care unit directors, nurse managers, frontline physicians and nurses in 14 hospitals across the United States.
Given the clinical and economic consequences of health-care associated infections, guidelines and recommendations have been made available to hospitals and clinicians to prevent them. Their availability, however, has not proven to be enough to ensure hospitals put them in place.
The study found that resistance to changes in practice was a pervasive problem. It also found the following themes as barriers to implementation:
1. Active resistance to changes in practice by attending physicians, resident physicians, or nurses. Hospitals used the following strategies to overcome active resistance:
- They collected data and provided feedback to physicians, presenting local data and comparing it with national rates.
- Physicians who didn’t think they needed to follow practices eventually did when guidelines had the strong support of the medical director or ICU physician on call.
- Physician leaders made compliance mandatory.
- Organizations selected an appropriate champion who could ‘speak the language’ of the staff they are trying to sway.
- Hospitals incorporated collaborative efforts aimed at preventing infection and used strategies that made it more difficult for resisters not to comply, such as packaging together in kits or carts the components required to promote maximum sterile barrier use.
2. The study also found the presence of ‘organizational constipators.’ These were mid- to high-level executives who prevented or delayed certain actions without active resistance thereby acting as insidious barriers to change by increasing the work required to implement changes. Once leadership recognized the negative effect on staff, the following techniques were used to overcome them:
- Hospitals included the person early in group discussions in order to improve communication and obtain buy-in.
- They worked around the individual, realizing that this was likely a short-term solution.
- They terminated the person’s employment.
- Took advantage of turnover opportunities and hired new people who were more likely to facilitate changes that were aligned with the organizational mission.
In conclusion, the study found that active resisters and ‘organizational constipators’ appeared to be significant impediments to translating research into practice. Active resistance to change was a universal problem in all study sites.
Sarah Krein, PhD, RN, VA research scientist and a lead researcher on the study, indicated that the research team hopes the study provides a starting point for discussion of personnel-related barriers and strategies to bolster efforts to prevent infections.
“Ideally, hospital administrators and patient safety leaders can use the findings to more successfully structure activities that prevent hospital acquired infections in their organizations,” says Krein.
The research team is using findings of this study in a separate National Institute of Nursing Research study that aims to reduce catheter-associated urinary tract infection in the state of Michigan and is doing so in collaboration with the Michigan Health & Hospital Association’s (MHA) KeystoneCenter for Patient Safety & Quality.
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