Many hospitals are unable to successfully implement “evidence-based practices” at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as “change implementation failure” in health care organizations. Several studies have used retrospective designs to examine the problem; however, there are few prospective studies examining communication dynamics underlying successful implementation of change (eg, evidence-based practices). This prospective study will be set in 2 intensive care units at an academic medical center. At baseline, both units have low compliance with CLB and higher-than-expected CRBSIs. Periodic quality improvement (QI) interventions will be conducted over a 52-week period to promote implementation of CLB in both units. Simultaneously, the following parameters will be examined: (1) Structure and content of communication related to CLB in both units through “communication logs” completed weekly by nurses, physicians, and managers; and (2) outcomes, that is, CLB adherence in both units through weekly chart review. Catheter utilization and CRBSI (infection) rates will serve as additional unit-level outcome measures. The aim is 2-fold: (1) to examine associations between QI interventions and structure and content of communication at the unit level; and (2) to examine associations between structure and content of communication and outcomes at the unit level. The periodic QI interventions are expected to increase CLB adherence and reduce CRBSIs through their influence on structure and content of communication. The prospective design would help examine dynamics in unit-level communication structure and content related to CLB, as well as unit-level outcomes. The study has potential to make significant contributions to theory and practice, particularly if interventions are found to be effective in enabling successful practice change at the unit level. To this effect, the study has potential to provide insights into communication structure and content associated with collective learning and culture change at the unit level. Results and insights are expected to lay a foundation for generating context-sensitive “evidence-based management” strategies for successful practice change at the unit level. An ultimate expected deliverable is the development of an “action-learning framework” for successful implementation of evidence-based practices in health care organizations.
Department of Health Management and Informatics, Georgia Health Sciences University, Augusta, Georgia.
Correspondence: Pavani Rangachari, PhD, Department of Health Management and Informatics, Georgia Health Sciences University, EB-1012, Augusta, GA 30912 (firstname.lastname@example.org).
The author thanks the following 3 individuals, whose support and contributions were invaluable in protocol development and subsequent grant application: (a) Dr R. Karl Rethemeyer, the author's primary statistical and “network analysis” consultant on this project; (b) Dr Peter Rissing, the author's primary practice collaborator at the study site; and (c) Dr Peggy Wagner, the author's consultant-related “content analysis.”
The study described in this protocol is currently being supported by grant number R03HS019785 from the Agency for Healthcare Research and Quality.
The author serves as principal investigator on this study, http://projectreporter.nih.gov/reporter.cfm (R03HS019785), and was sole author of this study protocol. The author developed the protocol from a “conceptual paper” and a “pilot study article” that the author published in 2010 (citations below).
Rangachari P. Knowledge sharing and organizational learning in the context of hospital infection prevention. Qual Manag Health Care. 2010;19(1):34–45.
Rangachari P, Rissing P, Wagner P, et al. A baseline study of communication networks related to evidence-based infection prevention practices in an intensive care unit. Qual Manag Health Care. 2010;19(4):330–348.