Highlights
- •Employee willingness to speak up about errors and opportunities for improvement is a hallmark of a health care safety culture and factor contributing to successful central line–associated bloodstream infection prevention efforts.
- •Interviews with 158 key informants at 6 hospitals across the United States found that organizational quality improvement and interdisciplinary care processes, along with leader behavior, employee training, and robust reporting systems, facilitated improvement-oriented speaking up related to central line–associated bloodstream infection prevention.
- •Although initiative-specific efforts are important to central line–associated bloodstream infection prevention, efforts to facilitate speaking up may be best implemented at the broader organizational level.
Background
Central line–associated bloodstream infections (CLABSIs) are associated with increased
morbidity, mortality, and cost for U.S. hospitals, but many infections are preventable.
Employees' willingness to speak up about errors or opportunities for improvement has
been associated with a stronger safety culture in hospitals. However, the link between
organizations' efforts to promote speaking up and prevent CLABSIs has not been studied.
Methods
This exploratory, qualitative study included interviews with 158 key informants, including
hospital executives, managers, and staff employees, in 6 hospitals that participated
in the federally funded On the CUSP—Stop BSI initiative. Verbatim transcripts were
analyzed to examine whether and how speaking up was addressed in CLABSI prevention
efforts.
Results
Hospitals implementing evidence-based practices for CLABSI prevention facilitated
employees' improvement-oriented speaking up by leveraging quality improvement and
care management processes. Leader behavior, employee training, and error reporting
systems also facilitated speaking up. Although the focus of this study was on CLABSI
prevention, broader organizational practices to improve patient safety were salient
in creating a nonpunitive, highly inclusive environment in which employees felt comfortable
speaking up.
Conclusions
These findings provide insight into the factors that may support speaking up to foster
a safety culture and prevent health care–associated infection at unit and organization
levels.
Key Words
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Article info
Publication history
Published online: April 26, 2016
Footnotes
Funding/Support: Supported by a contract awarded to the Health Research and Educational Trust by the Agency for Healthcare Research on Quality (contract no. HHSA290200600022, task order 5), on which The Ohio State University was a subcontractor.
Conflicts of Interest: None to report.
Disclaimer: The views expressed in this article are solely those of the authors and do not represent any U.S. government agency or any institutions with which the authors are affiliated.
Identification
Copyright
© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
