Active Resisters and Organizational Constipators: How Hospital Employees Affect Hospital‐Acquired Infection Prevention Efforts

1VA Ann Arbor Healthcare System, Ann Arbor, MI
2VA Ann Arbor Healthcare System, Ann Arbor, MI
3University of Michigan School of Public Health, Ann Arbor, MI
4VA Ann Arbor Healthcare System, Ann Arbor, MI
5VA Ann Arbor Healthcare System, Ann Arbor, MI
6VA Ann Arbor Healthcare System, Ann Arbor, MI

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 87

Background:

Health care–associated infection (HAI) is a common and costly patient safety problem. As of October 2008, U.S. hospitals will no longer receive Medicare reimbursement for certain types of HAI, thereby heightening the need for effective infection prevention efforts. The mere existence of evidence‐based practices, however, does not equal the use of such practices because of the complexities inherent in translating evidence into practice. We sought to understand the barriers to implementing evidence‐based practices to prevent HAI with a specific focus on the role played by hospital personnel.

Methods:

We conducted a qualitative study involving phone and in‐person interviews with personnel at 14 purposefully sampled hospitals from across the United States. There were 86 participants including: chief executive officers, chiefs of staff, hospital epidemiologists, infection control professionals, intensive care unit directors, nurse managers, and frontline physicians (including hospitalists) and nurses. We conducted full‐day site visits to 6 of these hospitals. Analyses were conducted using rigorous qualitative procedures; extensive summary reports — including 1 focusing specifically on hospital personnel — were generated for each site using all transcripts. These summaries were prepared independently by 4 members of the study team and emerging themes identified. Team members then met to question, discuss, and document interpretations and findings.

Results:

Active resistance involving hospital personnel who vigorously and openly opposed various changes in practice increased the difficulty of implementing practice change and was a universal problem for our study sites. Successful efforts to overcome active re‐sisters included benchmarking infection rates, redesigning key processes, identifying effective champions, and participating in collaborative efforts. Organizational constipators — mid‐ to high‐level executives who act as insidious barriers to change — also increased the difficulty in implementing change. Recognizing the presence of constipators is often the first step in addressing the problem but can be followed by including the constipator earlier in decision‐making to improve communication and obtain buy‐in, working around the individual, or terminating the constipator's employment.

Conclusions:

We identified multiple types of resistance that people engage in that impede HA! prevention activities. We also identified specific approaches used by hospitals to overcome those barriers, such as using benchmarked data, engaging local champions, and strategies for mitigating the powerful effect of organizational constipators by early inclusion, work‐arounds, or employment termination. Hospital administrators, patient safety leaders, and hospitalists can use our results to design more successful strategies to prevent HAI in their hospitals and thus decrease infection risk and improve patient safety.

Author Disclosure:

S. Saint, none; C. Kowalski, none; J. Banaszak‐Holl, none; J. Forman, none; L. Damschroder, none; S. Krein, none.

To cite this abstract:

Saint S, Kowalski C, Banaszak‐Holl J, Forman J, Damschroder L, Krein S. Active Resisters and Organizational Constipators: How Hospital Employees Affect Hospital‐Acquired Infection Prevention Efforts. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 87. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/active-resisters-and-organizational-constipators-how-hospital-employees-affect-hospitalacquired-infection-prevention-efforts/. Accessed May 26, 2019.

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