A Baseline Study of Communication Networks Related to Evidence-Based Infection Prevention Practices in an ICU

Recent hospital infection prevention success stories have suggested that “peer-to-peer communication networks,” where different professional subgroups (like physicians and nurses) directly communicate with each other regarding practice changes, with minimal interference from authority, may be most effective for improving performance on evidence-based practices. This argument contrasts with theoretical literature which suggests that “top-down communication networks,” may be most effective for learning and improvement in healthcare organizations.

This study seeks to gain a baseline understanding of the “communication network structure,” “content of communication,” and “outcomes” in a medical ICU experiencing higher-than-expected central line blood stream infection (CLBSI) rates. The “communication network structure” refers to the direction and frequency of communication on evidence-based CLBSI prevention practices across various professional subgroups and hierarchical levels in the unit, including medical faculty, nurses, residents, students, unit managers and hospital administrators. The “content of communication” refers to the type of knowledge (i.e., “tacit” vs. “explicit” knowledge) exchanged on CLBSI practices. Unit “outcomes” include 1) compliance with CLBSI prevention practices and 2) CLBSI rates.

Data on “communication network structure” and “content of communication” are collected using “communication logs” completed weekly for four weeks, by participants in each subgroup. “Outcomes” are collected through weekly chart review. Study results indicate a sparse communication network structure with minimal interaction across subgroups and levels. They also indicate that “explicit” knowledge on general infection topics is being exchanged as against “tacit” knowledge on specific practices.

The study represents an original attempt at developing methods for measuring unit level communication network structures related to evidence-based practices. It evaluates the feasibility of testing hypotheses related to effective communication network structures for hospital infection prevention. It also lays a foundation for generating strategies for organizational learning and improvement in the context of evidence-based practices. Such insight is critical from the perspective of “evidence-based healthcare management.”