The National Response for Preventing Healthcare-Associated Infections

Infrastructure Development

Published in: Medical Care, v. 52, no. 2, suppl. 1, Feb. 2014, p. S17-S24

Posted on RAND.org on February 01, 2014

by Peter Mendel, Sari Siegel, Kristin J. Leuschner, Elizabeth M. Gall, Daniel Weinberg, Katherine L. Kahn

Read More

Access further information on this document at Medical Care

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: In 2009, the US Department of Health and Human Services (HHS) launched the Action Plan to Prevent Healthcare-associated Infections (HAIs). The Action Plan adopted national targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control. OBJECTIVES: This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices. RESEARCH DESIGN: Interviews of federal (n=32) and other stakeholders (n=38), reviews of agency documents and journal articles (n=260), and observations of interagency meetings (n=17) and multistakeholder conferences (n=17) over a 3-year evaluation period. MEASURES: We extract key progress and challenges in the development of national HAI prevention infrastructure—1 of the 4 system functions in our evaluation framework encompassing regulation, payment systems, safety culture, and dissemination and technical assistance. We then identify system properties—for example, coordination and alignment, accountability and incentives, etc.—that enabled or hindered progress within each key development. RESULTS: The Action Plan has developed a model of interagency coordination (including a dedicated "home" and culture of cooperation) at the federal level and infrastructure for stimulating change through the wider healthcare system (including transparency and financial incentives, support of state and regional HAI prevention capacity, changes in safety culture, and mechanisms for stakeholder engagement). Significant challenges to infrastructure development included many related to the same areas of progress. CONCLUSIONS: The Action Plan has built a foundation of infrastructure to expand prevention of HAIs and presents useful lessons for other large-scale improvement initiatives.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.