The role of the "champion" in infection prevention: results from a multisite qualitative study

Damschroder, Laura J.; Banaszak-Holl, Jane; Kowalski, Charles J.; Forman, Jane; Saint, Sanjay; Krein, Sarah L.

doi:10.1136/qshc.2009.034199

Cited by 176 publications

(135 citation statements)

References 35 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Having someone with appropriate expertise in health information technology, or at the very least providing regular training and support to staff who must deal with such technology, is essential to any systems change initiative. 19,20 We acknowledge several limitations to our study. Because CEPACT is tasked with evaluating PACT implementation across the VISN, it was unfeasible to track pilot teams' activities more closely, and our face-to-face interactions with early adopters were limited to initial site visits and observations at Learning Collaboratives.…”

Section: Discussionmentioning

confidence: 99%

Open Access in the Patient-Centered Medical Home: Lessons from the Veterans Health Administration

et al. 2012

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Open Access in the Patient-Centered Medical Home: Lessons from the Veterans Health Administration

et al. 2012

View full text Add to dashboard Cite

“…Most sites had strong commitment by senior leadership, as reflected by financial and moral support, and the teams were led by local champions 16 who were often program directors and/or division chiefs. Implementation of the electronic patient registry was an early administrative challenge for many of the practices, but ultimately served as a vital tool for tracking change.…”

Section: Resultsmentioning

confidence: 99%

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

et al. 2010

View full text Add to dashboard Cite

BACKGROUND: There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE: To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN: US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure ≤130/80-and three process measures-retinal and foot examinations, and patient self-management goals-were tracked. PARTICIPANTS: Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS: Teaching-practice teams-faculty, residents and staff-participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS: Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS: These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable.

show abstract

“…Whereas change 'champions' can play a pivotal role in facilitating innovation, their effectiveness also depends on whether or not they can harness networks of support to carry it through. 80,118 Regarding PIE, those networks did not survive the 'champion's departure, although here too there appeared a lack of resources at ward level to pursue a service improvement process requiring 'headroom' to action.…”

Section: Non-implementers: Revisiting the Exploration And Adoption Stagementioning

confidence: 99%

“…This was one facet of a deeper organisational problem. Although change 'champions' who are in a position to harness support within an organisation can play a pivotal role in leading change, 80,118 personal influence may not outlast individuals in the absence of organisational support. PIE found no resonance at either ward or middle management levels: ward staff had neither the headroom to pursue service improvement nor the support from middle managers, whose priority was on managing performance, demand and patient flow.…”

Section: Organisational Turbulencementioning

confidence: 99%

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Godfrey

Young

Shannon

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal of service improvement. Objectives The Person, Interactions and Environment (PIE) Programme comprises an observation tool and a systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards, and develop insight into what person-centred care might look like in practice in this setting. Methods We performed a longitudinal comparative case study design in 10 purposively selected wards in five trusts in three English regions, alongside an embedded process evaluation. Data were collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records); and patient and ward aggregate data. Data were synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. A cross-case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data were analysed using simple descriptive statistics. A qualitative data analysis employed grounded theory methods. Results The study furthered the understanding of the dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’) or were ‘partial implementers’. The interaction between micro-level contextual factors [aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals] and meso- and macro-level organisational factors were the main barriers to PIE adoption. Evidence suggests that the programme, where implemented, directly affected improvements in ward practice, with a positive impact on the experiences of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations Although PIE has the potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes were not systematically collected, and PIE was not adopted on most study wards. Research implications Further research is required to identify more precisely the skill mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires a more in-depth understanding of the contextual factors that have an impact on the capacity of organisations to absorb and embed new practices. Funding The National Institute for Health Research Health Services and Delivery Research programme.

show abstract

The role of the "champion" in infection prevention: results from a multisite qualitative study

Abstract: The types and numbers of champions varied with the type of practice implemented and the effectiveness of champions was affected by the quality of organisational networks.

Cited by 176 publications

References 35 publications

Open Access in the Patient-Centered Medical Home: Lessons from the Veterans Health Administration

Open Access in the Patient-Centered Medical Home: Lessons from the Veterans Health Administration

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study

Contact Info

Product

Resources

About