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The new idea either finds a champion or dies.
Schon 1963
Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) are two common infections acquired in hospitals with serious and sometimes deadly consequences, as described in Box 1. The Centres for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee recommended several practices for preventing VAP and CLABSI. 1 2 However, many hospitals have not implemented these practices. 3 4
Box 1: VAP and CLABSI-prevalence and impact
VAP and CLABSI are two common infections acquired in hospitals with serious and sometimes deadly consequences. VAP is the most common type of hospital-acquired infection seen in the intensive care unit (ICU), 32 occurring in 10%-20% of patients receiving mechanical ventilation for more than 48 h 33 and is associated with substantial morbidity, mortality and excess healthcare costs. 33 More than 200,000 patients per year in the USA alone are affected by CLABSIs, 34 which are a serious complication of the often necessary use of short-term vascular catheters among hospital patients and are associated with an increased risk of death, 7 as well as significant increases in morbidity, length of stay and healthcare costs. 35 36
The significant consequences and costs associated with both VAP and CLABSI highlight the importance of efforts to prevent these conditions.
A wide range of contextual factors contribute to this failure. 5 For example, individuals may actively resist evidence-based practice change or executive leaders may create insidious barriers against change. 6 However, some individuals may actively champion the uptake of evidence-based clinical practices in their hospital, by working around or through organisational barriers. 7 8 Active champions directly shape organisational change through four critical functions: (1) protecting those involved in implementation from organisational rules and systems that may be barriers, (2) building organisational support for new practices, (3) facilitating the use of organisational resources for implementation and (4) facilitating growth of organisational coalitions in support of implementation. 8 A champion's effectiveness depends on the strategies used to engage individuals across professions, and engagement strategies must be tailored to the organisational setting. 9
The importance of having a champion to lead implementation efforts is well accepted in quality improvement. 10 However, little is understood about the factors that influence the...