Implementing best practice in infection prevention and control. A realist evaluation of the role of intermediaries

Journal article


Williams, L., Rycroft-Malone, J. and Burton, C. 2016. Implementing best practice in infection prevention and control. A realist evaluation of the role of intermediaries. International Journal of Nursing Studies. 60, pp. 156-167. https://doi.org/10.1016/j.ijnurstu.2016.04.012
AuthorsWilliams, L., Rycroft-Malone, J. and Burton, C.
Abstract

Background
Implementing best practice in healthcare is complex. There is evidence to suggest that certain individuals, collectively termed ‘intermediaries’, can contribute to implementation processes, but understanding exactly what happens and how intermediaries promote best practice is unclear.

Objectives
The aim of this study was to evaluate the role of intermediaries in promoting infection prevention, and provide an explanation about what works, for whom, how, and under which conditions.

Methods
Realist methodology was used as the underpinning explanatory framework for the study. From a concept mining of the existing literature, a set of hypothetical statements about the plausible range of context–mechanism–outcome propositions that postulate how intermediaries can contribute to promoting best practice were developed and evaluated.

Design
Case studies were conducted consecutively to refine and test the propositions. Data included semi-structured interviews (n = 32), non-participant observations (n = 5) and documentation review. Data were analysed by open coding, content and pattern matching.

Settings
Case studies were undertaken in two hospitals within the United Kingdom.

Participants
Purposive sampling was used to identify individuals within the organisations who had professional or organisational responsibilities for infection prevention. The inclusion criteria were; employees of the chosen organisations who would consent to take part in the study, participants with infection prevention responsibilities, adults over 18 years with the capacity to consent. The exclusion criteria were; participants outside of the chosen organisation, participants under 18 years of age, and participants who lacked the capacity to consent.

Results
Four context–mechanism–outcome configurations contribute to advancing our understanding about the potential of intermediaries to promote best practice. Findings showed that the ways in which intermediaries watch over practice (their human surveillance), promoted better adherence with infection control practices. Particular styles and approaches used by intermediaries led to individual staff feeling personally supported. Distinct ways of providing performance feedback for staff together with the policy discourse promoted good habitual behaviours. Practice-based teaching heightened awareness of individuals’ own practice and made learning more real.

Conclusions
Findings offer a new lens on the role of intermediaries in bridging the evidence to practice gap. As such they could be considered when reviewing or developing new interventions/programmes that use intermediaries to plug the gap between theory and practice. The findings could also be used to guide the design and development of new intermediary models in healthcare, to promote best practice and support the quality of patient care.

KeywordsBest practice; Implementation; Infection prevention and control; Intermediaries; Realist evaluation
Year2016
JournalInternational Journal of Nursing Studies
Journal citation60, pp. 156-167
PublisherElsevier
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2016.04.012
Official URLhttps://www.sciencedirect.com/science/article/abs/pii/S0020748916300323?via%3Dihub
Publication dates
Online21 Apr 2016
Publication process dates
Deposited27 May 2020
Output statusPublished
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Thomas, L. H., French, B., Sutton, C. J., Forshaw, D., Leathley, M. J., Burton, C., Roe, B., Cheater, F. M., Booth, J., McColl, E., Carter, B., Walker, A., Brittain, K., Whiteley, G., Rodgers, H., Barrett, J. and Watkins, C. L. 2015. Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care. NIHR Journals Library.
Collective action for knowledge mobilisation: a realist evaluation of the collaborations for leadership in applied health research and care
Rycroft-Malone, J., Burton, C., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams, L. 2015. Collective action for knowledge mobilisation: a realist evaluation of the collaborations for leadership in applied health research and care. UK NIHR Journals Library. https://doi.org/10.3310/hsdr03440
An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm
Burton, C. and Rycroft-Malone, J. 2015. An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm. International Journal of Health Policy and Management. 4 (12), pp. 845-847. https://doi.org/10.15171/ijhpm.2015.150
Investigating preferences for support with life after stroke: a discrete choice experiment
Burton, C., Fargher, E., Plumpton, C., Roberts, G.W, Owen, H. and Roberts, E. 2014. Investigating preferences for support with life after stroke: a discrete choice experiment. BMC Health Services Research. 14 (63). https://doi.org/10.1186/1472-6963-14-63
Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase.International journal of nursing studies
Thomas, L.H, French, B., Burton, C., Sutton, C., Forshaw, D., Dickinson, H., Leathley, M.J., Britt, D., Roe, B., Cheater, F.M, Booth, J., Watkins, C.L, ICONS Project Team, ICONS Patient and Public and Carer Involvement Groups 2014. Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase.International journal of nursing studies. International Journal of Nursing Studies. 51 (10), pp. 1308-1320. https://doi.org/10.1016/j.ijnurstu.2014.02.009
Improving skills and care standards in the support workforce for older people: a realist review
Rycroft-Malone, J., Burton, C., Hall, B., McCormack, B., Nutley, S., Seddon, D. and Williams, L. 2014. Improving skills and care standards in the support workforce for older people: a realist review. BMJ Open. 4 (5). https://doi.org/10.1136/bmjopen-2014-005356
Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review
Magklara, E., Burton, C. and Morrison, V. 2014. Does self-efficacy influence recovery and well-being in osteoarthritis patients undergoing joint replacement? A systematic review. Clinical Rehabilitation. 28 (9). https://doi.org/10.1177/0269215514527843
Towards a programme theory for fidelity in the evaluation of complex interventions.
Masterson-Algar, P., Burton, C., Rycroft-Malone, J., Sackley, C.M. and Walker, M.F. 2014. Towards a programme theory for fidelity in the evaluation of complex interventions. Journal of Evaluation in Clinical Practice . 20 (4), pp. 445 - 452. https://doi.org/10.1111/jep.12174
Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm.
Burton, C., Rycroft Malone, J., Robert, G., Willson, A. and Hopkins, A. 2014. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm. BMJ Open. 4:e005650. https://doi.org/10.1136/bmjopen-2014-005650
Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement.
Burton, C. and Rycroft-Malone, J. 2014. Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement. International Journal of Health Policy and Management. 3 (3), pp. 113 - 115. https://doi.org/10.15171/ijhpm.2014.74
The study protocol of: 'Initiating end of life care in stroke: clinical decision-making around prognosis'.
Burton, C., Payne, S., Turner, M., Bucknall, T., Rycroft-Malone, J., Tyrell, P., Horne, M., Ntambwe, L.I., Tyson, S., Mitchell, H., Williams, S. and Elghenzai, S. 2014. The study protocol of: 'Initiating end of life care in stroke: clinical decision-making around prognosis'. BMC Palliative Care. 13 (55). https://doi.org/10.1186/1472-684X-13-55
Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial.
Thomas, L.H., Watkins, C.L., Sutton, C.J., Forshaw, D., Leathley, M.J., French, B., Burton, C., Cheater, F., Roe, B., Britt, D., Booth, J., McColl, E., The ICONS Project Team and The ICONS Patient, Public and Carer Involvement Groups 2014. Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial. Trials. 15 (509). https://doi.org/10.1186/1745-6215-15-509
What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services
Burton, C.R., Horne, M., Woodward-Nutt, K., Bowen, A. and Tyrrell, P. 2014. What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services. Disability and Rehabilitation. 37 (21), pp. 1955-1960. https://doi.org/10.3109/09638288.2014.991454