INNOVATIVE THINKING
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Publication

Evaluation of the Infrastructure Development of the US Department of Health and Human Services' Action Plan

Title
The National Response for Preventing Healthcare-associated Infections: Infrastructure Development
Date
February 2014
Author(s)
Mendel, P., Siegel, S., Leuschner, K. J., Gall, E. M., Weinberg, D. A. & Kahn, K. L.
Publication
Medical Care
Market
IMPAQ Health
Citation
Mendel, P., Siegel, S., Leuschner, K. J., Gall, E. M., Weinberg, D. A. & Kahn, K. L. (2014). The National Response for Preventing Healthcare-associated Infections: Infrastructure Development. Medical Care, 52(2, Supplement 1), S17-S24. https://doi.org/10.1097/MLR.0000000000000044

Healthcare-associated infections (HAIs) occur when patients are seeking care for another condition and pick up an infection at their healthcare provider. The widespread prevalence of HAIs is so concerning that the US Department of Health and Human Services (HHS) created the Action Plan to Prevent Healthcare-associated Infections in 2009. This initiative identified certain HAIs to be targeted nationally over a 5-year period. As such, the HHS became accountable for this system change, even though federal agencies have limited control over the healthcare system.

To track the implementation of this Action Plan, Elizabeth Gall and Daniel Weinberg co-authored an article that examined the infrastructure created to ensure adoption of HAI prevention practices. To do this, researchers relied on interviews with 32 Federal and 38 other stakeholders, and reviews of 260 reports, agency documents, and journal articles. Researchers also observed interagency meetings and national multi-stakeholder conferences concerning this HAI initiative.

For each data source, researchers observed key progress and challenges of developing the infrastructure for the HHS initiative. The evaluation framework defined infrastructure as 1 of the 4 system functions that support adoption of HAI prevention practices: regulation and oversight, funding and payment systems, quality and safety culture, and dissemination and technical assistance programs. Focusing on infrastructure created at the Federal level, researchers identified the system properties within each progress/challenge area that helped or hindered progress on infrastructure development.

At the Federal level, the Action Plan created the infrastructure necessary to coordinate the envisioned change within the American healthcare system. This study showed how this desired large-scale change required an awareness of the many functions of the healthcare system, as well as prioritization of the different goals of an initiative. The Action Plan by HHS created a solid infrastructure through which different stakeholders can work to prevent HAIs and serves as a lesson for other large-scale infrastructure development initiatives.

The widespread prevalence and enormous cost of healthcare
targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control. This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices.