Final Report: Executive Summary (continued)
For this task order we conducted indepth case studies of health care organizations and intensive care units (ICUs) within these organizations to study whether and how the implementation of HPWPs facilitates successful reduction in HAIs, focusing particularly on CLABSIs.
This exploratory research was guided by the following overarching research questions:
- Do HPWPs facilitate the adoption and consistent application of practices known to reduce or prevent HAIs? In what ways?
- Is there a direct link between the implementation and use of HPWPs and HAI intervention outcomes?
- What distinguishes health care organizations that are more successful in adopting evidence-based practices in HAI reduction efforts from organizations with less effective HAI reduction efforts?
Case Study Process
The case studies included site visits between June 2011 and October 2012 to nine organizations that were actively implementing initiatives to prevent and reduce CLABSIs. We interviewed multiple key informants at each site, ranging from 14 to 38 interviewees per site; reviewed appropriate documents; and observed HAI initiatives in operation (e.g., team meetings) when possible. Our indepth approach was designed to enhance our understanding of the implementation and impact of HAI interventions, paying particular attention to the role of HPWPs in HAI reduction efforts.
We studied organizations from four States that participated in the first cohort (3 States) or second cohort (1 State) of the CUSP initiative. Within each participating State, we selected a pair of hospitals to recruit for our study that were matched on key organizational characteristics (e.g., size, rural vs. urban, academic vs. community) but had contrasting outcomes for CLABSI reduction (i.e., one was successful, one less so).
While nearly all of the participating hospitals had made notable improvements in CLABSI rates postintervention, some hospitals had virtually eliminated CLABSIs and maintained those results for 6 months or longer. We classified these hospitals as higher performers and designated as lower performers the hospitals that demonstrated less consistent results (e.g., variation among units or occasional sharp upticks in their infection rate trends).
We used an iterative process, based on a combination of analysis of objective data and application of subjective insight, to select sites for participation. In addition to the CUSP sites, we elected to study one hospital that had not participated in the CUSP cohorts but was included in our original HPWP study. We chose this hospital because we knew that it had a strong focus on HPWPs and had made efforts in HAI prevention. Table 1 gives a summary description of each site, including organizational characteristics and categories of key informants interviewed.
Case Study Data Collection
Across the nine sites in this study, we interviewed 223 key informants. These interviewees represent a diverse mix of clinical and nonclinical informants from different levels of the organization, including executives (n=36), managers (n=80), and frontline staff (n=107). Table 2 shows the number and type of key informants who participated in this study.
To ensure consistency in our data collection, we used a standard guide to conduct interviews, recognizing that the specific focus of the questions would vary based on the informant's role in the organization.
With informants' permission, interviews were recorded and then transcribed verbatim to ensure accuracy and reliability. The research team then analyzed the interview transcripts to identify themes both within and across sites, including developing summaries of the organizations' CLABSI prevention and reduction efforts, identifying facilitators and barriers to these efforts, and drafting an initial analysis of the role of HPWPs in CLABSI prevention efforts.
In addition to key informant interviews, the research team considered supplemental information obtained through project-related documents, such as reports, presentations, and observations of project operations (e.g., team meetings). Findings from these additional information sources were largely confirmatory and helped us to enhance or refine our primary findings from the key informant interviews.