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The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action

Journal article
Authors Ewa Wikström
Liselott (Lisen) Dellenborg
Lars Wallin
B M Gillespie
Annette Erichsen Andersson
Published in American Journal of Infection Control
Volume 47
Issue 3
Pages 251-257
ISSN 0196-6553
Publication year 2019
Published at Department of Business Administration, Management & Organisation
Institute of Health and Care Sciences
Pages 251-257
Language en
Keywords Implementation process, Hand hygiene, Aseptic technique, Contextual restructuring, Complex intervention, Co-creation.
Subject categories Business Administration


Background: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques. Methods: This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis. Results: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process. Conclusions: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

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