How to manipulate friends and influence practice: Application of complexity science leads to quality improvement in laboratory sample submissions

Abstract

Background:

We sought to reduce healthcare-associated infections (HCAIs) through the application of complexity science.

Objective:

To confirm incidental findings that altering the structure of microbiology reports with targeted education led to better utilisation of laboratory resources, while participating in efforts to reduce HCAI.

Methods:

We adopted a different approach to laboratory result authorisation, using narrative to engage the clinicians and induce behavioural change. Subsequent educational opportunities emphasised key messages.

Findings/Results:

Positive urine means calculated by the analysis tool numbered 2179/month throughout the study period. Negative urines started at 5576/month, reduced to 5134/month in November 2014 and to 4602/month in April 2016, coinciding with our changes. Opportunity costs were saved.

Discussion:

The changes in both policy and reporting were contemporaneous with a decline in negative samples. There were no significant changes in the number of positive specimens. The efficiency and effectiveness of the laboratory was improved and resources released: £145,000 ($182,000) for a resident population of 384,000. This suggests an annual release of about £25 million ($31 million) may be possible in the UK and £122 million ($155 million) in the USA.

Keywords

Behaviour healthcare-associated infections infection prevention quality improvement surveillance urinary tract infection complexity complex adaptive system

Get full access to this article

View all access options for this article.

References

Abernethy

Guy

Sheridan

Hopkins

Kiernan

Wilcox

Johnson

Hope

E. coli bacteraemia sentinel surveillance group. (2017) Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance Programme. Journal of Hospital Infection 95: 365–375.

Anderson

Reinhardt

Hussey

Petrosyan

. (2003) It’s the prices, stupid: why the United States is so different from other countries. Health Affairs 22: 89–105.

Baddour

Tholmer

Gavit

. (2009) Use of change-point analysis for process monitoring and control. BioPharm International 22: 46–55.

Braithwaite

. (2018) Changing how we think about healthcare improvement. British Medical Journal 361: k2014.

Finucane

. (2017) “Urinary tract infection”—requiem for a heavyweight. Journal of the American Geriatric Society 65:1650-5.

Kass-Hout

McMurray

et al . (2012) Application of change point analysis to daily influenza-like illness emergency department visits. Journal of the American Medical Informatics Association 19:1075–1081.

Morgan

Malani

Diekema

. (2017) Diagnostic stewardship - leveraging the laboratory to improve antimicrobial use. Journal of the American Medical Association 318:607–608

Ninan

Walton

Barlow

(2014) Investigation of suspected urinary tract infection in older people. British Medical Journal 348:g4070.

Office for National Statistics (2018). Midyear estimates 2017 (Release date 28^th June 2018) available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/latest accessed 15 December 2018

10.

Rich

(2017) Evaluation of the Bevan Innovators Exemplar Programme Cohort One. Bevan Commission, Swansea, UK ISBN 978–1–912334–00–1 available at: www.bevancommission.org/en/publications accessed 15 December 2018

11.

Simmons

. (2003) Complexity theory in the management of communicable diseases. Journal of Hospital Infection 54: 87–92.

12.

Simmons

. (2014) Reducing HCAI through a paradigm shift in strategic thinking: The law of multiple small positive returns. Hywel Dda University Health Board paper. Available at: http://www.wales.nhs.uk/sitesplus/documents/862/Att7fiiReducingHCAIThroughaParadigmShirftinStrategicThinkingReport.pdf (accessed 15 December 2018).

13.

Simmons

Daniel

. (2016) Complexity thinking in healthcare associated infections (HCAI). In: Bevan Commission Academy Innovators. 3rd ed. Swansea: Bevan Commission. Available at: http://www.bevancommission.org/getfile/Cohort1.pdf (accessed 15 December 2018).

14.

Simmons

Daniel

Temple

. (2019) Sepsis programme successes are responsible for the increase in bacteraemia detection. Journal of Hospital Infection 101: 93–99.

15.

Taylor

. (2000) Change point analysis: a powerful new tool for detecting changes. Available at: http://www.variation.com/cpa/tech/changepoint.html (accessed 15 December 2018).

16.

United States Census Bureau. (2016) US and world population clock - date field set to 1 July 2017. Available at: https://www.census.gov/popclock/ (accessed 15 December 2018).