The influence of organizational context on quality improvement and patient safety efforts in infection prevention: A multi-center qualitative study

Krein, Sarah L.; Damschroder, Laura J.; Kowalski, Charles J.; Forman, Jane; Hofer, Timothy P.; Saint, Sanjay

doi:10.1016/j.socscimed.2010.07.041

Cited by 121 publications

(136 citation statements)

References 23 publications

Supporting

Mentioning

123

Contrasting

Order By: Relevance

“…The need to adapt interventions to local context is widely acknowledged in the innovation and public sector management literature (Fervers et al 2006;Kirsh, Lawrence, and Aron 2008;Krein et al 2010;Mariano and Casey 2015). However, our data show that whilst facilitators, in theory, can rely on a wide range of tools and techniques to enable improvement (Smolović Jones, Grint, and Cammock 2015), in reality, their agency is severely constrained by the context they work in.…”

Section: Discussionmentioning

confidence: 79%

“…Our analysis highlights the malleability of the "core" components of managerial techniques under the influence of powerful institutional forces. In doing so, it responds to the call to explore the interrelationship between the host organizations of managerial innovation and their environment (Osborne and Brown 2005) and reveals potential unintended consequences stemming from the adaptation of managerial techniques to local contexts advocated by the innovation and implementation literature (Fervers et al 2006;Kirsh, Lawrence, and Aron 2008;Krein et al 2010;Mariano and Casey 2015).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How do managerial techniques evolve over time? The distortion of “facilitation” in healthcare service improvement

Kislov

Humphreys

Harvey

2016

Public Management Review

View full text Add to dashboard Cite

When applied to solving real-world problems in the public sector, managerial techniques are likely to evolve over time in response to the context of their implementation. The temporal dynamics of this evolution and its underlying processes, however, remain under-researched. To address this gap, we present a qualitative longitudinal case study of a UK-based knowledge mobilization programme utilizing "facilitation" as a service improvement approach. We describe the processes underpinning the distortion of facilitation over time and argue that an uncritical and uncontrolled adaptation of managerial techniques may mask the unsustainable nature of the resulting improvement outcomes captured by conventional performance measurement.

show abstract

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

How do managerial techniques evolve over time? The distortion of “facilitation” in healthcare service improvement

Kislov

Humphreys

Harvey

2016

Public Management Review

View full text Add to dashboard Cite

show abstract

“…However, there has been very limited systematic and independent analysis of the relationship between organisational factors, which shape the local context of health care, and the outcomes of patient safety interventions. 124,[216][217][218][219][220][221][222][223] In this study, guided by the established approach to realist inquiry, 228,241,242,247 we specified four main levels of contextual hierarchy: infrastructural system, institutional setting, interpersonal relations and individual. All levels except the individual are divided into substrata (see Figure 5).…”

Section: Discussionmentioning

confidence: 99%

“…However, although public inquiries and research evidence now concur that patient safety is, in part, a matter of context, 168 there has been very limited systematic and independent analysis of the relationship between organisational factors which shape the local context of health care and the outcomes of patient safety interventions. 124,[216][217][218][219][220][221][222][223] Prior to this study, relationships between the recently advocated 'four high-priority' features of organisational context: 5,223 (1) external factors such as regulatory requirements; (2) organisational structural characteristics; (3) leadership, team work and patient safety culture; and (4) management priorities -and the outcomes of safety programmes were both undertheorised and poorly understood in empirical terms. 224 As a result, the context of patient safety remained amorphous 225 and ill defined.…”

Section: Context Mattersmentioning

confidence: 99%

“…236,274 Building on findings from previous studies of the design 237 implementation, 21,220,238,239 and outcomes 146,240 of patient safety improvement programmes, we examine the implementation of three focal interventions in a multisite comparative-intensive case study of hospitals in NHS Wales. We seek to reveal the complex interplay of context and concerns, 234,235 captured through the organisational factors and competing institutional logics -belief systems -which guide acceptance of, or resistance to, the local adoption and adaptation of patient safety programmes.…”

Section: Aim and Objectivesmentioning

confidence: 99%

See 1 more Smart Citation

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Reducing Inappropriate Urinary Catheter Use

Watson²,

et al. 2012

View full text Add to dashboard Cite

Background Indwelling urinary catheters may lead to both infectious and non-infectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use. Methods Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention-promoting adherence to appropriate urinary catheter indications. The data was collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of engaging clinicians about the appropriate indications for urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence with appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methodology to estimate rates over time while accounting for the clustering of patients within hospital units. Results The urinary catheter utilization rate decreased from 18.1% (95% CI: 16.8–19.6) at baseline to 13.8% (95% CI: 12.9–14.8) at end of year 2 (p <0.001). The proportion of catheterized patients with appropriate indications increased from 44.3% (95% CI: 40.3–48.4) to 57.6% (95% CI: 51.7–63.4) by the end of year 2 (p = 0.005). Conclusions A statewide effort to reduce inappropriate urinary catheter utilization was associated with a significant reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years. Word count: 249

show abstract

The influence of organizational context on quality improvement and patient safety efforts in infection prevention: A multi-center qualitative study

Cited by 121 publications

References 23 publications

How do managerial techniques evolve over time? The distortion of “facilitation” in healthcare service improvement

How do managerial techniques evolve over time? The distortion of “facilitation” in healthcare service improvement

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Reducing Inappropriate Urinary Catheter Use

Contact Info

Product

Resources

About