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Continuous Finding Problems and Implementing Solutions in Health Care-Associated Infections: The Role of Infection Preventionists
Högskolan i Halmstad, Akademin för företagande, innovation och hållbarhet, Centrum för innovations-, entreprenörskaps- och lärandeforskning (CIEL). FURB, Blumenau, Brazil.ORCID-id: 0000-0001-9033-3957
2020 (Engelska)Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This licentiate thesis aims to understand how infection preventionists (IPs) continuously find problems and implement solutions related to health care-associated infections (HAIs) in hospital settings.

HAIs are infections acquired by patients during the process of care and are among the main causes of deaths worldwide. Recently, practices for HAIs prevention and control have challenged IPs due to pandemics (e.g. COVID-19), antimicrobial resistance, population aging and limited resources in health care facilities. Such challenges demand actions to find, solve problems and implement solutions. However, IPs often fail to address these problems. The reasons stem from their inability to timely identify valuable problems and implement new solutions. Although the literature on infection prevention and control is well developed, previous studies have largely investigated how IPs implement preconceived practices to solve given problems as a single event, rather than on how to continuously find problems and implement solutions. 

This licentiate thesis comprises two empirical papers. Paper I investigates how infection prevention and control teams find problems with HAIs, and is based on a multiple case study of three infection prevention and control teams from one Swedish and two Brazilian hospitals. Paper II investigates how IPs continuously implement changes in infection prevention and control practices during pandemics, and is based on a qualitative descriptive study. The data in both papers were collected from 44 semi-structured interviews with health care professionals enrolled as IPs in Brazilian and Swedish hospitals. The key theories and literatures covered include Problem-Finding and Problem-Solving Perspective and Implementation research.

This licentiate thesis contains three main contributions. First, it advances the Problem-Finding and Problem-Solving Perspective literature by providing empirical evidence on how to create valuable knowledge from ill-structured and complex problems. Second, this licentiate thesis suggests a distinction between HAI prevention and HAI control based on two modes of decision-making for finding valuable problems with HAIs. Third, the licentiate thesis describes and categorizes sets of practices that allow to continuously implement changes of infection prevention and control practices during pandemics. 

Ort, förlag, år, upplaga, sidor
Halmstad: Halmstad University Press, 2020. , s. 168
Serie
Halmstad University Dissertations ; 70
Nyckelord [en]
Health Care-Associated Infections, Infection Prevention and Control, Infection Preventionists, Problem-Finding and Problem-Solving Perspective, Implementation of Changes
Nationell ämneskategori
Företagsekonomi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
URN: urn:nbn:se:hh:diva-42965ISBN: 978-91-88749-48-2 (tryckt)OAI: oai:DiVA.org:hh-42965DiVA, id: diva2:1460161
Presentation
2020-09-15, S1080, Spetsvinkelgatan 11, Halmstad, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2020-09-01 Skapad: 2020-08-21 Senast uppdaterad: 2020-09-01Bibliografiskt granskad
Delarbeten
1. What’s the Problem? How Infection Prevention and Control Teams Find Problems with Health Care-Associated Infections
Öppna denna publikation i ny flik eller fönster >>What’s the Problem? How Infection Prevention and Control Teams Find Problems with Health Care-Associated Infections
2019 (Engelska)Konferensbidrag, Publicerat paper (Övrigt vetenskapligt)
Abstract [en]

Background: Health care-associated infections (HAIs) are among the major causes of death of hospitalized patients. The ability to find and solve problems relating to HAIs is heavily contingent on infection prevention and control (IPC) teams’ practices. Previous studies provide detailed insights into how IPC teams find appropriate solutions, but they do not addressed how problems are found. This limitation is a severe drawback as IPC teams may focus their attention on the wrong problems that leads to inefficient or suboptimal solutions.

Purpose: This study aims to understand how IPC teams find problems with HAIs from a Problem-Finding and Problem-Solving perspective.

Method: We performed a multiple case study of three hospitals located in Brazil and Sweden. We collected data from 3 exploratory interviews and 13 semi-structured interviews with nurses and physicians enrolled in IPC teams. Supplemented documents were used for data triangulation. Data were analyzed using a thematic approach.

Findings: Results from this study suggest an approach based on two different sets of activities for finding problems: practices for HAI prevention and for HAI control. Practices for HAI prevention comprises routinely and elective actions whereas practices for HAI control involve ad hoc and emergent actions. The practices are organized into problem-detection, -framing, and -formulation activities.

Conclusion: We identified and detailed practices that guide IPC teams’ attention to find valuable problems relating to HAIs. By detecting, framing and formulating problems, IPC teams can find appropriate solutions.

Practice Implications: A range of practices are detailed in our study to guide IPC teams’ attention in how to find relevant problems relating to HAI prevention and control as well as the criteria on how to prioritize latent problems to obtain needed solutions. Our study provides a basis for supporting decision makers on how to identify opportunities for improve IPC policies and practices.

Nyckelord
Health Care-Associated Infections, Infection Prevention and Control, Infection Prevention and Control Teams, Problem-Finding and Problem- Solving Perspective
Nationell ämneskategori
Företagsekonomi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
urn:nbn:se:hh:diva-42963 (URN)
Konferens
3rd Young Scholars of Scandinavian Academy of Industrial Engineering and Management (ScAIEM) Workshop in Espoo, Finland, April 11, 2019
Forskningsfinansiär
Vinnova
Anmärkning

Funding: This study was financed in part by the Clean Care project (Vinnova) and by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Brazil - Finance Code 001.

Tillgänglig från: 2020-08-21 Skapad: 2020-08-21 Senast uppdaterad: 2020-08-31Bibliografiskt granskad
2. Facilitation activities for change response: a qualitative study on infection prevention and control professionals during a pandemic in Brazil
Öppna denna publikation i ny flik eller fönster >>Facilitation activities for change response: a qualitative study on infection prevention and control professionals during a pandemic in Brazil
2021 (Engelska)Ingår i: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 35, nr 7, s. 886-903Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: Facilitation activities support implementation of evidence-based interventions within healthcare organizations. Few studies have attempted to understand how facilitation activities are performed to promote the uptake of evidence-based interventions in hospitals from resource-poor countries during crises such as pandemics. This paper aims to explore facilitation activities by infection prevention and control (IPC) professionals in 16 hospitals from 9 states in Brazil during the COVID-19 pandemic.

Design/methodology/approach: Primary and secondary data were collected between March and December 2020. Semi-structured interviews were conducted with 21 IPC professionals in Brazilian hospitals during the COVID-19 pandemic. Public and internal documents were used for data triangulation. The data were analyzed through thematic analysis technique.

Findings: Building on the change response theory, this study explores the facilitation activities from the cognitive, behavioral and affective aspects. The facilitation activities are grouped in three overarching dimensions: (1) creating and sustaining legitimacy to continuous and rapid changes, (2) fostering capabilities for continuous changes and (3) accelerating individual commitment. Practical implications: During crises such as pandemics, facilitation activities by IPC professionals need to embrace all the cognitive, behavioral and affective aspects to stimulate positive attitudes of frontline workers toward continuous and urgent changes.

Originality/value: This study provides unique and timely empirical evidence on the facilitation activities that support the implementation of evidence-based interventions by IPC professionals during crises in hospitals in a resource-poor country.

© 2021, Luís Irgang, Magnus Holmén, Fábio Gama and Petra Svedberg

Ort, förlag, år, upplaga, sidor
Bingley: Emerald Group Publishing Limited, 2021
Nyckelord
Facilitation activities, Change response, Implementation of changes, evidence-based interventions, COVID-19 pandemic, infection prevention and control professionals
Nationell ämneskategori
Företagsekonomi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
urn:nbn:se:hh:diva-42964 (URN)10.1108/JHOM-12-2020-0506 (DOI)000687715400001 ()2-s2.0-85113739653 (Scopus ID)
Forskningsfinansiär
KK-stiftelsen
Anmärkning

Earlier title: Continuous Implementation in Infection Prevention and Control Practices During Pandemics

Tillgänglig från: 2020-08-21 Skapad: 2020-08-21 Senast uppdaterad: 2023-12-05Bibliografiskt granskad

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Irgang dos Santos, Luís Fernando
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FöretagsekonomiHälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

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