Abstract
SummaryBackgroundCentrally led performance management regimes using standard setting, monitoring, and incentives have become a prominent feature of infection prevention and control (IPC) in health systems.AimTo characterize views and experiences of regulation and performance management relating to IPC in English hospitals.MethodsTwo qualitative datasets containing 139 interviews with healthcare workers and managers were analysed. Data directly relevant to performance management and IPC were extracted. Data analysis was based on the constant comparative method.FindingsParticipants reported that performance management regimes had mobilized action around specific infections. The benefits of establishing organizational structures of accountability were seen in empirical evidence of decreasing infection rates. Performance management was not, however, experienced as wholly benign, and setting targets in one area was seen to involve risks of ‘tunnel vision’ and the marginalization of other potentially important issues. Financial sanctions were viewed especially negatively; performance management was associated with risks of creating a culture of fearfulness, suppressing learning and disrupting inter-professional relationships.ConclusionCentrally led performance management may have some important roles in IPC, but identifying where it is appropriate and determining its limits is critical. Persisting with harsh regimes may affect relationships and increase resistance to continued improvement efforts, but leaving all improvement to local teams may also be a flawed strategy.
Highlights
As in other countries worldwide, the landscape of infection prevention and control (IPC) in the English National HealthService (NHS) has been shaped in recent years by extensive policy-driven performance management
By the mid-2000s public concern about healthcare-associated infections (HCAIs) had grown, fuelled by media reporting, patient pressure groups, litigation and complaints, and reputational damage associated with specific cases of failings.3e5 In response, the Department of Health seized the initiative for making change happen
Source 2 included interviews with 98 individuals: the majority were clinical staff, including consultant and registrar-level physicians, service improvement leads, specialist nurses, infection control practitioners, and managers. Across both sources we identified themes relating to both positive and negative consequences of performance management
Summary
As in other countries worldwide, the landscape of infection prevention and control (IPC) in the English National HealthService (NHS) has been shaped in recent years by extensive policy-driven performance management. L. Brewster et al / Journal of Hospital Infection 94 (2016) 41e47 change and for appropriate actions in order to improve.[2] by the mid-2000s public concern about HCAIs had grown, fuelled by media reporting, patient pressure groups, litigation and complaints, and reputational damage associated with specific cases of failings.3e5 In response, the Department of Health seized the initiative for making change happen. Brewster et al / Journal of Hospital Infection 94 (2016) 41e47 change and for appropriate actions in order to improve.[2] by the mid-2000s public concern about HCAIs had grown, fuelled by media reporting, patient pressure groups, litigation and complaints, and reputational damage associated with specific cases of failings.3e5 In response, the Department of Health seized the initiative for making change happen From this point onwards, performance management, led from the centre, became a prominent feature of IPC in England (Table I)
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