Abstract
BackgroundImplementation science experts define champions as “supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.” Many hospitals use designated clinical champions—often called “hand hygiene (HH) champions”—typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term “HH champion” and how they define the role.MethodsAn ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes.ResultsA total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role.ConclusionsHealthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance—and differentiate it from the role of a “compliance auditor.” Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
Highlights
Implementation science experts define champions as “supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.” Many hospitals use designated clinical champions—often called “hand hygiene (HH) champions”—typically to improve hand hygiene compliance
A total of 38 individuals responsible for or involved with hand hygiene programs participated in semi-structured interviews, while 70 frontline staff participated in focus groups in the Table 1 (T1) interviews
In Table 2 (T2) interviews, individuals responsible for or involved with hand hygiene programs participated in semi-structured interviews, and frontline staff participated in focus groups
Summary
Implementation science experts define champions as “supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.” Many hospitals use designated clinical champions—often called “hand hygiene (HH) champions”—typically to improve hand hygiene compliance. In the USA, the Joint Commission’s 2019 National Patient Safety Goal challenges hospitals to lower the risk of HAI by utilizing current Centers for Disease Control and Prevention [5] or World Health Organization hand hygiene guidelines [2, 6]. It recommends that hospitals set their own goals for hand hygiene compliance and work toward improving compliance toward those goals [7]. One approach many hospitals use to improve hand hygiene compliance is the recruitment of clinical champions—often called “hand hygiene (HH) champions.”. Champions are often referred to by a variety of different titles, such as opinion leaders, sponsors, internal entrepreneurs, and change agents [13, 14]
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