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Explaining Matching Michigan: an ethnographic study of a patient safety program
Open accessAbstract
BACKGROUND: Quality and safety improvement initiatives in healthcare often display two disconcerting effects. The first is a failure to outperform the secular trend. The second is the decline effect, where an initially promising intervention appears not to deliver equally successful results when attempts are made to replicate it in new settings. Matching Michigan, a patient safety program aimed at decreasing central line infections in over 200 intensive care units (ICUs) in England, may be an example of both. We aimed to explain why these apparent effects may have occurred. METHODS: We conducted interviews with 98 staff and non-participant observation on 19 ICUs; 17 of these units were participating in Matching Michigan. We undertook further telephone interviews with 29 staff who attended program training events and we analyzed relevant documents. RESULTS: One Matching Michigan unit transformed its practices and culture in response to the program; five boosted existing efforts, and 11 made little change. Matching Michigan's impact may have been limited by features of program design and execution; it was not an exact replica of the original project. Outer and inner contexts strongly modified the program's effects. The outer context included previous efforts to tackle central line infections superimposed on national infection control policies that were perceived by some as top-down and punitive. This undermined engagement in the program and made it difficult to persuade participants that the program was necessary. Individual ICUs' histories and local context were also highly consequential: their past experience of quality improvement, the extent to which they were able to develop high quality data collection and feedback systems, and the success of local leaders in developing consensus and coalition all influenced the program's impact on local practices. CONCLUSIONS: Improved implementation of procedural good practice may occur through many different routes, of which program participation is only one. The 'phenotype' of compliance may therefore arise through different 'genotypes.' When designing and delivering interventions to improve quality and safety, risks of decline effects and difficulties in demonstrating added value over the secular trend might be averted by improved understanding of program mechanisms and contexts of implementation.
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“Initiatives to improve quality and safety in healthcare all too frequently result in limited changes for the better or no meaningful changes at all, and the few that are successful are often hard to sustain or replicate in new contexts.1”
From Demystifying theory and its use in improvement (2015) · cites this paper as [1]
In the citing paper
“Initiatives to improve quality and safety in healthcare all too frequently result in limited changes for the better or no meaningful changes at all, and the few that are successful are often hard to sustain or replicate in new contexts.1”
From Demystifying theory and its use in improvement (2015) · cites this paper as [1]
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“The well-known Michigan Keystone initiative to reduce CLABSI (Central Line Insertion Bloodstream Infection) infections is a good case study of looking at a successful project to try to understand why it worked [47], and why a subsequent replication did not [45].”
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BackgroundA Smartphone Application for Teamwork and Communication in Trauma: Pilot Evaluation “in the Wild”
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Implementierungsstrategien für Hygienemaßnahmen
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“Die Inzidenz zu Beginn der Surveillance entsprach jeweils derjenigen der vorangegangenen Gruppe zum gleichen Zeitpunkt [11,13].”
BackgroundInfluentialMeasuring and improving patient safety culture: still a long way to go
Trbovich, P., & Griffin, M. R. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-005038 · Cited by 8
Mascherek, A., Gehring, K., Bezzola, P., & Schwappach, D. L. B. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1122-7 · Cited by 7
“A multitude of possible reasons on organisational as well as individual level have been proposed to explain low compliance rates, for example lack of knowledge [10] and the way the checklist is implemented in the first place and how it is accompanied by supportive activities [11].”
BackgroundYang, F. B., Walker, S., Richardson, G. A., Stephens, T., Phull, M., Thompson, A., & Pearse, R. M. (2019) · International Journal of Surgery · doi:10.1016/j.ijsu.2019.10.001 · Cited by 8
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“10 Also, health care professionals developed their skills in health care improvement when they perceived an alignment between their motivations and the organisational structures of and resources for the QIC initiative.”
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“Our findings confirm the results of implementation studies within health services in general [21, 32, 35, 52] and the few existing QIC implementation studies, which have stated that QICs are not implemented linearly, but shaped by various translations and depended on local negotiations [9, 17, 21].”
ResultFixing patient safety: Are we nearly there yet?
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Preventing healthcare-associated MRSA bacteremia: getting to the root of the problem
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“Despite not having government affiliation, qualitative research demonstrated common concerns among staff that the intervention represented another top-down, externally imposed initiative with the potential for data to be used for performance management and public shaming purposes [26].”
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“…both the challenges involved in de-implementing interventions that have proved to have minimal effect [9] and also identifying that an intervention that was implemented successfully in one healthcare setting will not necessarily transfer to a different setting with the same success [43].”
BackgroundStudying Organizational Culture in Surgery
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“It is therefore necessary to explore and understand why and which evidence-based interventions work and for whom [24].”
BackgroundSelf-citationI-CATCH: A Novel Bundle to Improve Postcall Morning Handoffs
Zipursky, J. S., Dhhar, G., Weinerman, A. S., Stroud, L. F., & Wong, B. M. (2018) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-18-00178.1 · Cited by 4
Keystone, Matching Michigan, and Bacteremia Zero
Bion, J., & Dixon‐Woods, M. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000190 · Cited by 4
Self-citation
Metadata
- Authors
- Dixon-Woods, M., Leslie, M., Tarrant, C., & Bion, J.
- Affiliations
- Johns Hopkins University (US)
- University of Leicester (GB)
- Queen Elizabeth Hospital Birmingham (GB)
- Venue
- Implementation Science
- Published
- 2013-06-20
- Volume
- 8
- Issue
- 1
- Pages
- 70-70
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3704826
- OpenAlex
- W2153352637
- Cited by
- 291
- References
- 28
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 18 · 2023: 21 · 2022: 23 · 2021: 18 · 2020: 25 · 2019: 57 · 2018: 21 · 2017: 25 · 2016: 29 · 2015: 30 · 2014: 12 · 2013: 4
- FWCI
- 45.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (097899, 097899/A/11/Z)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Keywords
- patient safety programs, central line-associated bloodstream infection, intensive care unit, quality improvement, decline effect, secular trends, program implementation, context effects, infection control, employee engagement, local leadership, intervention replication
- MeSH terms
- Anthropology, Cultural, Catheterization, Central Venous, Critical Care, Cross Infection, England, Humans, Infection Control, Catheter-Related Infections, Quality Improvement, Patient Safety
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