Structure and content of communication enabling successful implementation of evidence-based practices in healthcare organizations

Many hospitals have been unable to successfully implement “evidence-based practices” (like for example, the central line bundle—CLB, which is proven to prevent catheter-related bloodstream infections—CRBSIs). This problem has been broadly characterized as “change implementation failure” in healthcare organizations (HCOs).

This prospective study sought to understand which structures of communication and types of knowledge exchanges are associated with successful implementation of evidence-based practices in HCOs. The study was set in two intensive care units at an academic medical center. At baseline, both units had low compliance with CLB and higher-than-expected CRBSIs.

The aim was to promote implementation of CLB in both units through periodic quality improvement and action-learning interventions over a 52-week period, and simultaneously examine: 1. Structure and content of communication related to CLB in both units through “communication logs” completed weekly by nurses, physicians, and managers; and 2. Outcomes, i.e., CLB compliance in both units through weekly chart review.

During the course of the study, both units experienced substantially improved CLB compliance, significantly reduced CRBSI rates, and dramatically reduced catheter utilization. Analysis of over 4,300 instances of communication collected from both units revealed intensification of communication over time across physicians and nurses, and dramatic changes in content exchanged from “reactive” protocol-based checks to “proactive” communications for reducing infection risk. In short, physicians and nurses not only began to communicate more often, but also began to use their relationships to proactively reduce infection risk.

Results suggest that the periodic interventions to promote CLB adherence were effective in reformatting inter-professional communication dynamics, and in enabling practice change in both units. The prospective design also provides insights into effective communication structure and content for learning and culture change at the unit level. Overall, the study helps identify “evidence-based management” strategies for successful implementation of practice change at the frontlines of care delivery.