Organizational impact of evidence-informed decision making training initiatives : a case study comparison of two approaches

Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs

Possible Association between Obesity and Clostridium difficile Infection

Inflammatory bowel disease (IBD) is a risk factor for Clostridium difficile infections (CDIs). Because of similar disruptions to the intestinal microbiome found in IBD and in obesity, we conducted a retrospective study to clarify the role of obesity in CDI. We reviewed records of patients with laboratory-confirmed CDIs in a tertiary care medical center over a 6-month period. Of 132 patients, 43% had community onset, 30% had health care facility onset, and 23% had community onset infections after exposure to a health care facility. Patients with community onset infections had higher body mass indices than the general population and those with community onset after exposure to a health care facility, had higher rates of IBD, and lower prior antibacterial drug exposure than patients who had CDI onset in a health care facility. Obesity may be associated with CDI, independent of antibacterial drug or health care exposures