Objective: Evaluate the experience and impact of the programme in promoting and embedding the prevention of healthcare associated infections (HAI) as ‘everybody’s responsibility’ and identifying the contexts and mechanisms that were critical to improvement.
Methods: A multiple methods design using nine case studies and existing programme data. Case studies were purposively selected to provide perspectives from national health service (NHS) acute care trusts (ACT) of varying sizes and complexity and facing different levels of challenge in reducing their MRSA bacteraemias. Data was collected using qualitative interviews with key individuals and practitioner groups and documentary and observational data. Analysis was undertaken using a realist framework (Pawson and Tilley 1997) to identify what worked for whom in what circumstances?
Results: Setting a national target was crucial to raising the profile of preventing HAI generally and MRSA bacteraemias in particular. NHS ACT emerged as being Improvement Resistant or Improvement Responsive. The programme and targeted support team were catalysts in moving trusts with high numbers of MRSA bacteraemias from ‘resistance to responsiveness' and creating the conditions for:
- A cultural shift.
- Supporting and cultivating leaders and champions.
- Challenging denial and complacency.
- Driving a shared understanding of where the ACT problems lay through better date, information systems and feedback.
- Changing the mindset of practitioners through the use of root cause analysis.
- Increasing the reliability of evidence based care practices.