Banaszak-Holl J (Univ of Michigan, School of Public Health), Krein SL
(VA Ann Arbor HSR&D COE), Kowalski CP
(VA Ann Arbor HSR&D COE), Forman J
(VA Ann Arbor HSR&D COE), Saint S
(VA Ann Arbor HSR&D COE)
Guidelines and collaboratives have endorsed specific evidence-based practices for reducing hospital-acquired infections (HAI) but these practices are far from being universally implemented. We examine the processes and roles of organizational champions who can advocate and drive implementation of effective practices in order to clarify where previous research has been mixed on the efficacy of champions in implementing change.
We conducted a national mixed-methods study evaluating organizational barriers and facilitators of HAI practices. Following a survey of VA hospitals and a random sample of non-VA hospitals in the US, we selected 14 hospitals for in-depth analysis using stratified purposeful sampling based on survey responses. We interviewed 86 individuals using semi-structured questions with follow-up visits to 6 hospitals. All interviews were transcribed, coded, and analyzed using rigorous qualitative content analysis techniques.
Champions navigate the dynamic and complex interactions between the practices being implemented and their organizational context. We found that the types and numbers of champions varied with the type of practice implemented and how that practice interacted with structural features of the organization. While some literature promotes the use of physician champions, we found that professional identity, job role, and functional role of champions, along with the strategies they use, varies. For example, having a physician “opinion leader” with technical expertise is often not sufficient, and particularly when an HAI practice affects nursing practice, having a nurse champion(s) was needed for frontline nurse compliance. In some cases, a highly-placed physician champion worked alongside a nursing champion. We found champions demonstrate traits and skills such as risk-taking and the development of strong personal relationships that facilitated implementation of new practices, although sometimes even these characteristics were not enough to overcome overwhelming organizational barriers.
Multiple champions may be needed to effectively implement HAI prevention practices. Champions exhibit common traits and skills, regardless of role. Understanding the interaction of the practice and organization is crucial for explaining the mixed effects of appointing champions.
Identifying multiple champions, while considering the influential role of and individual traits and skills, can help move VA toward its transformational goal of eliminating HAIs.