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Soc Sci Med. 2010 Nov;71(9):1692-701. doi: 10.1016/j.socscimed.2010.07.041. Epub 2010 Sep 28.

The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study.

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VA Ann Arbor Healthcare System, HSR&D (11H), 2215 Fuller Road, Ann Arbor, MI 48105, United States.


Patient safety is a healthcare priority worldwide, with most hospitals engaging in activities to improve care quality, safety and outcomes. Despite these efforts, we have limited understanding of why quality improvement efforts are successful in some hospitals and not others. Using data collected as part of a multi-center study, we closely examined quality improvement efforts and the implementation of recommended practices to prevent central line-associated bloodstream infections (CLABSI) in U.S. hospitals. We compare and contrast the experiences among hospitals to better understand 'how' and 'why' certain hospitals were more successful with practice implementation when taking into consideration specific aspects of the organizational context. This study reveals that among a number of hospitals that focused on implementing practices to prevent CLABSI, the experience and outcomes varied considerably despite using similar implementation strategies. Moreover, our findings provide important insights about how and why different quality improvement strategies might perform across organizations with differing contextual characteristics.

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