Agile Implementation reduces central line-associated blood stream infections

Agile Implementation, an easy to localize and apply change methodology that enables fast, efficient, effective, scalable and sustainable implementation of evidence-based healthcare solutions, reduced central-line associated bloodstream infections by a 30 percent, according to a study going to be recently published in the American Journal of Infection Control.

Central line-associated bloodstream infections are among the most common hospital-acquired infections that can have serious consequences including death.

"We borrowed Agile Implementation from the world of software development and created a novel blueprint for change management in healthcare because we see a huge need for rapid implementation of evidence-based solutions to pressing problems in current healthcare delivery," said Malaz Boustani, senior author of the study.

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"Our focus in this study is a hospital-acquired infection, but the Agile Implementation methodology provides a universal platform to implement evidence-based innovation in any environment in which humans are the major players," Dr. Boustani said. "It can be successfully employed in finance, manufacturing, technology or a dozen other fields as well as in health care."

The study was conducted at two urban hospitals with the application of the eight steps of Agile Implementation where 30 percent reduction in central-line bloodstream infections, as well as decreased rates of Clostridium difficile (commonly called C.difficile) infections were attained. The C.difficile bacterium causes a serious form of colitis. It can produce diarrhea as well as more serious symptoms and surgical wound infections.

"Agile Implementation enables us to effectively implement existing evidence but it's not an assembly line quality improvement, we aren't trying to put a square peg into a round hole," said study first author Jose Azar. "As we went through the eight steps of Agile Implementation, we spent a lot of time involving all the players - doctors, nurses and other clinicians as well as infection control specialists - so they came to realize that the problem, in this case, central-line bloodstream infection, is a problem they want to be a part of solving. Engagement, rapidly discarding what doesn't work, and moving on to other possible solutions, are key to the process.”

"We saw a genuine shift in the culture regarding patient safety events," said Dr. Azar. "The punitive attitude toward these types of events that existed before Agile Implementation evolved into an environment focused on shared learning and collaboratively improving care quality."

Using feedback from participants, Agile Implementation focuses on selecting the best evidence-based solutions to implement in a given situation and on how to implement these solutions to provide the best care possible. Three questions are posed: 1) What do we do that works well? 2) What does not work well? 3) What do we plan to do differently based on what we have learned?

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"Accountability engages people incredibly," said Dr. Azar. "Agile Implementation directs us to investigate existing evidence-based solutions and let everyone know that we won't waste time on partially effective practices. We won't give up until we accomplish what we set out to do - find a solution that works and is sustainable for our environment."

"There may be a lot of existing evidence about solving problems and providing the best care, but that's not the issue," said Dr. Boustani. "What has been missing is how to determine the best solution for the problem in a specific place, how to implement it - with the word implement being underlined - and how to continually monitor the solution."

"We have shown that for aging brain care, ICU survivorship and now hospital-acquired infection, Agile Implementation can make a major and rapid contribution to improving quality and it can be done at any hospital, anywhere," Dr. Boustani said. "We are transforming healthcare from 1.0 to 2.0 where we can provide better health, lower cost, and delightful patient and provider experiences."