Developing a knowledge management framework for facilities management services for the control of exogenous healthcare associated infections (HCAI) in NHS hospitals

Abstract

The occurrence and adverse complications arising from healthcare associated infections (HCAIs) have been well documented as one of the leading causes of morbidity and mortality by successive governments and healthcare professional bodies in the United Kingdom (UK). The significance of these challenges has led to a plethora of published regulatory guidance and continuous surveillance tools that focus on good practice. These good practice guidance documents are aimed at reducing the prevalence of both endogenous (internal) and exogenous (external) healthcare associated infections in NHS hospitals. However, there is an acknowledgment that a huge gap still exists between the implementation of knowledge accumulated over the years from the use of these good practice guidance documents and the monitoring tools adopted for benchmarking compliance with good practice in the prevention of HCAIs. With the increasing evidence of the contribution of the healthcare environment to the prevalence of HCAIs, expert opinion has affirmed that the scope for the prevention of healthcare-associated infections no longer rests only within the remit of medicines, but includes other key service providers to the healthcare sector, among which the facilities management discipline is paramount. This has led to a research need for a better understanding of the subtleties of knowledge management processes in healthcare facilities management practice. The aim of this research is to examine the issues of the knowledge management process, i.e. the creation, storing, sharing and usage of knowledge in hospital facilities management cleaning services for the control of exogenous HCAIs. This investigation was carried out within the context of hospital knowledge infrastructure capabilities, which consist of the prevailing culture, structure and technological capabilities. The research is premised on an interpretivist research philosophy and utilises a sequential explanatory mixed methodology approach. This approach consists of the synthesis and review of literature pertinent to the research subject domain, a questionnaire survey and face-to-face interviews. Quantitative data was obtained from a questionnaire survey of 81 NHS hospital facilities managers in England, and was subjected to rigorous statistical analysis. Qualitative data was obtained from face-to-face interviews with 10 NHS facilities managers and subjected to thematic analysis using NVivo software. Findings across the three data collection instruments were contextualised and subjected to further rigorous statistical analysis using the Relative Importance Index (RII), also known as the “weighted models”, to ascertain the empirical importance of the variables. The findings obtained were used to develop a good practice knowledge management framework. Findings from the research showed that efficient management of compliance with good practice guidance protocols in the control of exogenous HCIAs is could be achieve through the provision of cleaning services using directly employed in-house staff. This enables a high level of collaboration between the clinician members of an infection control team and a hospital facilities manager in the control of exogenous HCAIs. The majority of the NHS hospitals surveyed use their bespoke good practice guidance documents in the delivery of hospital cleaning services. These bespoke guidance documents are a combination of key performance indicators (KPIs) drawn from prevailing statutory core guidance documents. There is evidence of a lack of appreciation and understanding of the relevance of interfacing knowledge management processes to the hospital knowledge infrastructure capabilities in the delivery of facilities management cleaning services for efficient control of exogenous HCAIs. A conceptual knowledge management framework representing the fundamental empirical interface of the knowledge management process elements within the hospital knowledge infrastructure capabilities was developed to assist in the control of exogenous HCAIs through facilities management cleaning service delivery practices in NHS hospitals. This framework was validated by facilities managers across NHS hospitals in England to ascertain its feasibility from both the analytical (scientific) and pragmatic (operational) perspectives