Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/32595
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dc.contributor.authorDixon-Woods, Mary-
dc.contributor.authorLeslie, M.-
dc.contributor.authorTarrant, Carolyn-
dc.contributor.authorBion, J.-
dc.date.accessioned2015-07-13T08:21:20Z-
dc.date.available2015-07-13T08:21:20Z-
dc.date.issued2013-06-20-
dc.identifier.citationImplementation Science 2013, 8 : 70en
dc.identifier.urihttp://www.implementationscience.com/content/8/1/70en
dc.identifier.urihttp://hdl.handle.net/2381/32595-
dc.description.abstractBACKGROUND: Quality and safety improvement initiatives in healthcare often display two disconcerting effects. The first is a failure to outperform the secular trend. The second is the decline effect, where an initially promising intervention appears not to deliver equally successful results when attempts are made to replicate it in new settings. Matching Michigan, a patient safety program aimed at decreasing central line infections in over 200 intensive care units (ICUs) in England, may be an example of both. We aimed to explain why these apparent effects may have occurred. METHODS: We conducted interviews with 98 staff and non-participant observation on 19 ICUs; 17 of these units were participating in Matching Michigan. We undertook further telephone interviews with 29 staff who attended program training events and we analyzed relevant documents. RESULTS: One Matching Michigan unit transformed its practices and culture in response to the program; five boosted existing efforts, and 11 made little change. Matching Michigan's impact may have been limited by features of program design and execution; it was not an exact replica of the original project. Outer and inner contexts strongly modified the program's effects. The outer context included previous efforts to tackle central line infections superimposed on national infection control policies that were perceived by some as top-down and punitive. This undermined engagement in the program and made it difficult to persuade participants that the program was necessary. Individual ICUs' histories and local context were also highly consequential: their past experience of quality improvement, the extent to which they were able to develop high quality data collection and feedback systems, and the success of local leaders in developing consensus and coalition all influenced the program's impact on local practices. CONCLUSIONS: Improved implementation of procedural good practice may occur through many different routes, of which program participation is only one. The 'phenotype' of compliance may therefore arise through different 'genotypes.' When designing and delivering interventions to improve quality and safety, risks of decline effects and difficulties in demonstrating added value over the secular trend might be averted by improved understanding of program mechanisms and contexts of implementation.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urihttp://www.ncbi.nlm.nih.gov/pubmed/23786847-
dc.rightsCopyright © 2013 Dixon-Woods et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en
dc.subjectAnthropology, Culturalen
dc.subjectCatheter-Related Infectionsen
dc.subjectCatheterization, Central Venousen
dc.subjectCross Infectionen
dc.subjectEnglanden
dc.subjectHumansen
dc.subjectInfection Controlen
dc.subjectIntensive Careen
dc.subjectPatient Safetyen
dc.subjectQuality Improvementen
dc.titleExplaining Matching Michigan: an ethnographic study of a patient safety programen
dc.typeJournal Articleen
dc.identifier.doi10.1186/1748-5908-8-70-
dc.identifier.eissn1748-5908-
dc.identifier.pii1748-5908-8-70-
dc.description.statusPeer-revieweden
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article;Research Support, Non-U.S. Gov't-
pubs.organisational-group/Organisationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGYen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciencesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themes/Populationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themes/RESULTen
dc.dateaccepted2013-06-11-
Appears in Collections:Published Articles, College of Medicine, Biological Sciences and Psychology

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