Organizational readiness for implementing infection control in European hospitals: insights from Coincidence Analysis

Healthcare-associated infections (HAIs) are a threat to public health, however, infection prevention and control (IPC) interventions have been shown to prevent a substantial portion of HAIs. Due to the interrelatedness of IPC intervention components, multifaceted implementation strategies, and contextual factors, IPC implementation is intricate. Organizational readiness for change (ORC) has been labelled as critical to ensure successful implementation, yet it is unclear under which conditions this is the case. We aim to examine if ORC is a necessary and/or sufficient condition for IPC implementation in REVERSE, a study aimed at decreasing multidrug-resistant HAIs in Europe.

We conducted a crisp-set Coincidence Analysis on data from the 24 hospitals enrolled in REVERSE to examine necessary and sufficient conditions for IPC implementation. We collected quantitative data on change complexity, implementation leadership, ORC, and sustainability. Implementation strategies used, as well as both theory-based outcomes of initiation and cooperative behavior, were assessed qualitatively. Models were selected based on theoretical grounds, fit indices, and case knowledge.

Twelve hospitals (50%) had high IPC implementation initiation. We found two alternative pathways explaining this outcome. When hospitals implemented highly complex IPC practices, they needed high ORC levels to initiate change. When complexity was low, ORC did not shape initiation, but sites rather had to show clearly matched implementation barriers and strategies to initiate IPC. Results for cooperative behavior were inconclusive.

Using a novel cross-case configurational approach, we uncovered the role of ORC for IPC implementation. We found that ORC is of importance under the condition of highly complex change. When change complexity is low, solidifying ORC is dispensable, and efforts should instead be directed towards a thoughtful and targeted selection of implementation strategies based on identified barriers. These findings have implications for implementers and decision-makers, who may allocate resources based on whether IPC implementation is anticipated to be of high complexity or not, to ensure proper IPC implementation to address HAIs.

REVERSE was registered with the "International Standard Randomised Controlled Trial Number" (ISRCTN) register under Nr. 12956554 on 11.11.2021, https://www.isrctn.com/ISRCTN12956554 .