The evolution of knowledge exchanges enabling successful practice change in two intensive care units

Pavani Rangachari, Michael P. Madaio, R. Karl Rethemeyer, Peggy Wagner, Lauren Hall, Siddharth Roy, Peter Rissing

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.

Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.

Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.

Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.

Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.

Original languageEnglish (US)
Pages (from-to)65-78
Number of pages14
JournalHealth Care Management Review
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Intensive Care Units
Communication
Catheter-Related Infections
Physicians
Organizational Innovation
Nurse Administrators
Evidence-Based Practice
Quality Improvement
Intensive care unit
Knowledge exchange
Catheters
Nurses
Learning
Prospective Studies
Delivery of Health Care
Health
Infection
Adherence
Champions
Top-down

Keywords

  • change implementation
  • communication and knowledge exchange
  • culture of safety
  • evidence-based management
  • evidence-based practices
  • infection prevention
  • mixed-method research

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Strategy and Management

Cite this

The evolution of knowledge exchanges enabling successful practice change in two intensive care units. / Rangachari, Pavani; Madaio, Michael P.; Rethemeyer, R. Karl; Wagner, Peggy; Hall, Lauren; Roy, Siddharth; Rissing, Peter.

In: Health Care Management Review, Vol. 40, No. 1, 01.01.2015, p. 65-78.

Research output: Contribution to journalArticle

Rangachari, Pavani ; Madaio, Michael P. ; Rethemeyer, R. Karl ; Wagner, Peggy ; Hall, Lauren ; Roy, Siddharth ; Rissing, Peter. / The evolution of knowledge exchanges enabling successful practice change in two intensive care units. In: Health Care Management Review. 2015 ; Vol. 40, No. 1. pp. 65-78.
@article{07e210bcdb9b43c0965db2ec77429e5f,
title = "The evolution of knowledge exchanges enabling successful practice change in two intensive care units",
abstract = "Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.",
keywords = "change implementation, communication and knowledge exchange, culture of safety, evidence-based management, evidence-based practices, infection prevention, mixed-method research",
author = "Pavani Rangachari and Madaio, {Michael P.} and Rethemeyer, {R. Karl} and Peggy Wagner and Lauren Hall and Siddharth Roy and Peter Rissing",
year = "2015",
month = "1",
day = "1",
doi = "10.1097/HMR.0000000000000001",
language = "English (US)",
volume = "40",
pages = "65--78",
journal = "Health Care Management Review",
issn = "0361-6274",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The evolution of knowledge exchanges enabling successful practice change in two intensive care units

AU - Rangachari, Pavani

AU - Madaio, Michael P.

AU - Rethemeyer, R. Karl

AU - Wagner, Peggy

AU - Hall, Lauren

AU - Roy, Siddharth

AU - Rissing, Peter

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.

AB - Background: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as change implementation failure.Purpose: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap.Methods: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly communication logs completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews.Practice Implications: The study helps identify evidence-basedmanagement strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.Findings: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in proactive communicationsVthat is, communications intended to reduce infection riskVbetween physicians and nurses over time. Further analysis revealed that, during the early phase of the study, champions emerged within each unit to initiate process improvements.

KW - change implementation

KW - communication and knowledge exchange

KW - culture of safety

KW - evidence-based management

KW - evidence-based practices

KW - infection prevention

KW - mixed-method research

UR - http://www.scopus.com/inward/record.url?scp=84918812013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84918812013&partnerID=8YFLogxK

U2 - 10.1097/HMR.0000000000000001

DO - 10.1097/HMR.0000000000000001

M3 - Article

C2 - 24153028

AN - SCOPUS:84918812013

VL - 40

SP - 65

EP - 78

JO - Health Care Management Review

JF - Health Care Management Review

SN - 0361-6274

IS - 1

ER -