Using a Positive Deviance Approach to Influence the Culture of Patient Safety Related to Infection Prevention

Pranavi Sreeramoju, Lucia Dura, Maria E. Fernandez, Abu Minhajuddin, Kristina Simacek, Thomas B. Fomby, Bradley Doebbeling

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. Health care-associated infections (HAIs) are a socio-technical problem. We evaluated the impact of a social change intervention on health care personnel (HCP), called positive deviance (PD), on patient safety culture related to infection prevention among HCP. Methods. This observational study was done in 6 medical wards atan 800-bed public academic hospital in the United States. Three of these wards were randomly assigned to receive PD intervention on HCP. After a retrospective 6-month baseline period, PD was implemented over 9 months, followed by 9 months of follow-up. Patient safety culture and social networks among HCP were surveyed at 6, 15, and 24 months. Rates of HAI were measured among patients. Results. The measured patient safety culture was steady over time at 69% aggregate percent positive responses in wards with PD vs decline from 79% to 75% in wards without PD (F statistic 10.55; P = .005). Social network maps suggested that nurses, charge nurses, medical assistants, ward managers, and ward clerks play a key role in preventing infections. Fitted time series of monthly HAI rates showed a decrease from 4.8 to 2.8 per 1000 patient-days (95% confidence interval [CI], 2.1 to 3.5) in wards without PD, and 5.0 to 2.1 per 1000 patient-days (95% CI, -0.4 to 4.5) in wards with PD. Conclusions. A positive deviance approach appeared to have a significant impact on patient safety culture among HCP who received the intervention. Social network analysis identified HCP who are likely to help disseminate infection prevention information. Systemwide interventions independent of PD resulted in HAI reduction in both intervention and control wards.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Volume5
Issue number10
DOIs
StatePublished - Oct 1 2018

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Patient Safety
Health Personnel
Safety Management
Cross Infection
Delivery of Health Care
Infection
Social Support
Supervisory Nursing
Confidence Intervals
Public Hospitals
Social Change
Observational Studies
Nurses

Keywords

  • health care personnel
  • infection control
  • patient safety culture
  • positive deviance
  • social networks.

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Using a Positive Deviance Approach to Influence the Culture of Patient Safety Related to Infection Prevention. / Sreeramoju, Pranavi; Dura, Lucia; Fernandez, Maria E.; Minhajuddin, Abu; Simacek, Kristina; Fomby, Thomas B.; Doebbeling, Bradley.

In: Open Forum Infectious Diseases, Vol. 5, No. 10, 01.10.2018.

Research output: Contribution to journalArticle

Sreeramoju, Pranavi ; Dura, Lucia ; Fernandez, Maria E. ; Minhajuddin, Abu ; Simacek, Kristina ; Fomby, Thomas B. ; Doebbeling, Bradley. / Using a Positive Deviance Approach to Influence the Culture of Patient Safety Related to Infection Prevention. In: Open Forum Infectious Diseases. 2018 ; Vol. 5, No. 10.
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