Hand Washing Clinical Trial
Official title:
Strengthening Organization to Implement Evidence-based Clinical Practice
Evidence-based clinical practices (EBCPs) are often not widely adopted, despite extensive efforts to influence individual practitioners to use them. The aim of the project is to work with Veterans Integrated Service Networks (VISN) 1, 10, and 23 and their medical centers to create and test organizations that facilitate the use of EBCPs. The research objectives are to: Test the effectiveness of the proposed organizational model in comparison with a more limited data-feedback strategy in improving system use of a selected EBCP; Identify and analyze organizational factors that affect model implementation; Test the feasibility of intervention activities to introduce and support the model.
Background:
The Veterans Health Administration (VHA) needs to develop efficient ways to broadly
implement evidence based practices and foster a learning organization culture that
systematically and continuously applies research to improve VA healthcare. Recognizing this
need, VHA Health Services Research and Development (HSR&D) invited applications in the fall
of 2003 for collaboration HSR&D investigators and Integrated Service Networks (VISNs) on a)
implementing and evaluating an evidenced-based interventions or b) undergoing and evaluating
an organizational or structural change to transform the VISN in to a learning organization
that can efficiently implement evidence-based practices. Collaborations are intended to help
improve clinical services locally within participating VISNs and provide templates for
expanding successful changes nationwide.
Objectives:
Despite recognition that successful implementation of evidence-based clinical practices
(EBCPs) usually depends on the on the structure and processes of the larger healthcare
organization in which new clinical practices are introduced, the processes and dynamics of
implementation are not well understood. The aim of this project was to deepen that
understanding by testing an organizational model that we hypothesized would strengthen the
ability of healthcare organizations to implement evidence-based clinical practices. The
research objectives were to: - Test the hypothesis that medical centers with high fidelity
to the organizational model would be more successful in improving system use of a selected
EBCP; - Identify and analyze organizational factors that affect model implementation; - Test
the feasibility of intervention activities to introduce and support the model.
Methods:
The three-year study used a mixed-methods pre-post comparison-group design to implement and
evaluate the organizational model in medical centers in 3 VISNs in the Department of
Veterans Affairs. The model posits that the implementation of evidence-based practices will
be enhanced through the presence of three interacting components in the organization: 1)
active leadership commitment to quality, 2) robust clinical process redesign to incorporate
evidence-based practices into routine operations, and 3) use of management structures and
processes to support and align redesign. The target clinical practice was hand-hygiene
compliance. One VISN was randomly assigned to the intervention arm that implemented the
organizational model; two VISNs were assigned to a comparison arm that participated in a
more limited data feedback strategy. Measures included: 1) ratings of implementation
fidelity, as measured on a 0-4 scale at the site level supported by narrative evidence by
research team; 2) percent compliance with national hand-hygiene guidelines for each site, as
measured through structured observations by medical center staff; 3) staff ratings of team
effectiveness and facility emphasis on quality, as measured through a written survey; and 4)
factors affecting model implementation, as identified qualitatively through interviews and
quantitatively through staff surveys
Status:
Data collection and analysis is complete. Manuscript preparation is ongoing.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Open Label
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