AHRQ Case Study Analysis Pinpoints Success Factors for Reducing Central Line-Associated Bloodstream Infections

An analysis of case studies of health care organizations that participated in AHRQ’s Comprehensive Unit-based Safety Program (CUSP) national implementation project has identified management practices and “success factors” in reducing and eliminating central line-associated bloodstream infections (CLABSIs) in health care facilities. AHRQ has funded numerous projects to prevent and reduce healthcare-associated infections as part of its patient safety mission, including CUSP, which intensive care units across the country used to reduce CLABSIs by 41 percent. In this analysis, “High-Performance Work Practices in CLABSI Prevention Interventions,” AHRQ-funded researchers conducted in-depth case studies of health care organizations and intensive care units that participated in a CUSP implementation project to study whether and how high-performance work practices facilitate successful reduction of healthcare-associated infections, focusing particularly on CLABSIs. Researchers concluded that the following management practices lead to the reduction of CLABSIs in health care settings: engaging staff, acquiring and developing talented employees, empowering frontline providers and aligning leaders. Researchers also identified six factors widely evident in health care facilities that reduce CLABSIs and missing or inconsistently applied in lower-performing facilities. Included were frontline accountability, strong leadership and use of data.

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High-Performance Work Practices in CLABSI Prevention Interventions

Final Report: Executive Summary

This analysis of case studies developed from participants in AHRQ's Comprehensive Unit-based Safety Program (CUSP) national implementation project describes specific practices and "success factors" for reducing and eliminating central line-associated bloodstream infections (CLABSIs) in health care facilities.

Prepared by: Ann Scheck McAlearney, Sc.D., M.S., Professor, Family Medicine, Vice Chair for Research, Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio.i

Introduction
Background
Project Scan Findings
Case Studies
Key Findings
Conclusions
References
Bibliography
Appendix 1. Definitions of High-Performance Work Practices

Introduction

This final project report summarizes the results of nine indepth case studies we completed as part of a modification to the ACTION (Accelerating Change and Transformation in Organizations and Networks) Task Order "Promoting Safety and Quality Through Human Resource Practices," titled "Extending the Search for High-Performance Work Practices (HPWPs) in Healthcare-Associated Infection (HAI) Interventions." Findings are based on 223 key informant interviews completed across the nine sites.

Sites studied in this project included one site originally studied during the first phase of this task order and eight new health care organizations selected based on their participation in the federally funded Comprehensive Unit-based Safety Program (CUSP) initiative, designed to reduce central line-associated bloodstream infections (CLABSIs). We used the case study format to explore whether and how the implementation of HPWPs facilitates successful reduction of CLABSIs.

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Background

The research team consisted of researchers from The Ohio State University (Ann Scheck McAlearney, Sc.D., M.S., and Julie Robbins, Ph.D., M.H.A.) and Rush University (Andrew Garman, Psy.D.).

The project had two components:

A "project scan," in which the research team reviewed the literature and research on HAI prevention to determine the most appropriate focus for our case study research.
Comparative qualitative research to explore the role of management practices in facilitating HAI prevention and reduction efforts at nine case study hospitals.

This report presents the findings from both project components.

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Project Scan Findings

The project scan was completed in fall 2010. At that time, numerous efforts were underway to reduce HAIs, but much of this work had not yet been well documented in the peer-reviewed literature. Therefore, our scan focused mainly on prepublication reports and conference presentations, which were supplemented by interviews with key researchers and practitioners in the field. With input from our Agency for Healthcare Research and Quality project officer and two clinical consultants to the team, we reached out to 14 experts and conducted a total of eight interviews, each lasting between 60 and 90 minutes.

Findings from the scan were organized around five key framing questions for our subsequent research design:

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This project was funded under contract number HHSA2902010000221, Task Order No. 5, from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated.

i. Contact Information for Ann Scheck McAlearney: (614) 438-6869; (614) 292-0662; mcalearney.1@osu.edu.

Page last reviewed May 2015

Internet Citation: High-Performance Work Practices in CLABSI Prevention Interventions: Final Report: Executive Summary. May 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-hpwpreport/index.html