The role of the "champion'' in infection prevention: results from a multisite qualitative study
The role of the "champion'' in infection prevention: results from a multisite qualitative study
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DOI：
10.1136/qshc.2009.034199
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Krein, S. L.
中科院分区：
文献类型：
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作者：
Damschroder, L. J.;Banaszak-Holl, J.;Krein, S. L.
背景资料：尽管20%或更多的医疗相关感染是可以预防的，但许多医院尚未实施已知的减少感染的做法。我们探讨了类型和数量的冠军谁领导的努力，以实施最佳实践，以防止医院获得性infection in US hospitals.Methods：定性分析内进行了多地点，连续混合方法的研究，在美国退伍军人事务部和非退伍军人事务部医院的感染预防实践。第一阶段包括2005-2006年在14家专门选定的医院对38名个人进行的电话访谈。第二阶段利用第一阶段的研究结果，在2006- 2007年选择了6家医院进行现场访问，并对另外48名个人进行了访谈。结果：一个位置合适的冠军可以实施一项新技术，但当一项改进需要人们改变行为时，需要一个以上的冠军。虽然改变行为本身似乎是一种廉价和简单的解决办法，但实施往往比改变技术更为复杂，因为改变行为需要专业间的联合合作。在医院中，各单位或专业之间的工作关系质量低下的冠军在实施行为改变方面面临特别大的挑战。仅仅任命拥护者是无效的;相反，成功的拥护者往往对他们所推广的做法有内在的动力和热情。即使广泛的实施受阻，冠军可以实施自己的势力范围内的变化。结论：冠军的类型和数量不同的类型的实践实施和冠军的有效性受到影响的质量的组织网络。
Background: Although 20% or more of healthcare-associated infections can be prevented, many hospitals have not implemented practices known to reduce infections. We explored the types and numbers of champions who lead efforts to implement best practices to prevent hospital-acquired infection in US hospitals.Methods: Qualitative analyses were conducted within a multisite, sequential mixed methods study of infection prevention practices in Veteran Affairs and non-Veteran Affairs hospitals in the USA. The first phase included telephone interviews conducted in 2005-2006 with 38 individuals at 14 purposively selected hospitals. The second phase used findings from phase 1 to select six hospitals for site visits and interviews with another 48 individuals in 2006-2007.Results: It was possible for a single well-placed champion to implement a new technology, but more than one champion was needed when an improvement required people to change behaviours. Although the behavioural change itself may appear to be an inexpensive and simple solution, implementation was often more complicated than changing technology because behavioural changes required interprofessional coalitions working together. Champions in hospitals with low-quality working relationships across units or professions had a particularly challenging time implementing behavioural change. Merely appointing champions is ineffective; rather, successful champions tended to be intrinsically motivated and enthusiastic about the practices they promoted. Even when broad implementation is stymied, champions can implement change within their own sphere of influence.Conclusions: The types and numbers of champions varied with the type of practice implemented and the effectiveness of champions was affected by the quality of organisational networks.